Individual
HAILELEOUL DESTA ERBELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8118 GORMAN AVE, APT # 104, LAUREL, MD 20707
(202) 723-4448
Mailing address
8118 GORMAN AVE APT 104, LAUREL, MD 20707-2536
(202) 723-4448
(202) 723-4494
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
C0003952
MD
363AM0700X
Medical Physician Assistant
Primary
PA030586
DC
Other
Enumeration date
12/28/2010
Last updated
12/28/2010
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