Individual
BENYAM D ADDISSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 NORTH ACADEMY AVE, DANVILLE, PA 17822-2111
(570) 271-6439
(570) 271-6852
Mailing address
100 NORTH ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 214-5681
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
55198
MN
207RG0100X
Gastroenterology Physician
Primary
55198
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01165806
RAILROAD MEDICARE
MN
Enumeration date
06/16/2011
Last updated
08/30/2020
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