Individual provider · Type 1 NPI
Haileleoul Desta Erbello, PA
Medical Physician Assistant · Laurel, MD
NPI number
1760786172
Active
Practice location
8118 Gorman Ave, Apt # 104
Laurel, MD 20707
Mailing address
8118 Gorman Ave Apt 104
Laurel, MD 20707-2536
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | PA030586 (DC) |
| Medical Physician Assistant | 363AM0700X | C0003952 (MD) |
Medical Physician Assistant: Definition to come...
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About NPI 1760786172
Haileleoul Desta Erbello, PA's National Provider Identifier is 1760786172, issued on Dec 28, 2010. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Laurel, MD. The record was last updated on Dec 28, 2010.