Individual
BERHANE ADHANOM GEBRESELASIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 S GEORGE ST, 3RD FLOOR, YORK, PA 17403-3676
(717) 851-4005
(717) 812-2495
Mailing address
3450 WAYNE AVE APT 5G, BRONX, NY 10467-2518
(917) 515-2344
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD455139
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103043499
—
PA
Enumeration date
10/23/2012
Last updated
02/21/2017
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