Basic Information
| Provider Information | |||||||||
| NPI: | 1750338075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEGENE | ||||||||
| FirstName: | AKLILU | ||||||||
| MiddleName: | MERSHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1430 | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228031430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645791 | ||||||||
| FaxNumber: | 5404334123 | ||||||||
| Practice Location | |||||||||
| Address1: | 2006 HEALTH CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228018679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406895600 | ||||||||
| FaxNumber: | 5406895601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 10/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 0101238021 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1000870001 | 01 | VA | DME PROVIDER | OTHER | 321619 | 01 | SOUTHERN HEALTH | OTHER | 96956 | 01 | VA | OPTIMA | OTHER | 179962 | 01 | ANTHEM/BCBS | OTHER | 3810002958 | 01 | WV MEDICAID | OTHER | 010173639 | 05 | VA | MEDICAID | 3364824 | 01 | CIGNA | OTHER | P00234595 | 01 | VA | RAILROAD MEDICARE | OTHER |