Basic Information
Provider Information
NPI: 1356652028
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASNAKE
FirstName: SELAMAWIT
MiddleName: ABRAHAM
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2041 GEORGIA AVE NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200600001
CountryCode: US
TelephoneNumber: 2028657151
FaxNumber: 2028657199
Practice Location
Address1: 2041 GEORGIA AVE NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200600001
CountryCode: US
TelephoneNumber: 2028657151
FaxNumber: 2028657199
Other Information
ProviderEnumerationDate: 06/28/2010
LastUpdateDate: 12/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XD0076843MDY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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