Individual
MS. MISGANA MESFIN BELEGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
Mailing address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001005631
NC
363AS0400X
Surgical Physician Assistant
Primary
PA030536
MD
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487813465
1487813465
—
Enumeration date
06/05/2008
Last updated
11/05/2019
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