HAILELEOUL DESTA ERBELLO PA NPI 1760786172

NPI Information

NPI: 1760786172
Provider Name: HAILELEOUL DESTA ERBELLO, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: MEDSTAR MEDICAL GROUP II LLC

PECOS Registration: Yes

Address:
8118 GORMAN AVE
APT # 104
LAUREL, MD
ZIP 20707
Phone: (202) 723-4448
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Haileleoul Desta Erbello, PA is a medical physician assistant in Laurel, MD with 16 years of experience. Haileleoul Desta Erbello, PA NPI is 1760786172. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

8118 GORMAN AVE
APT # 104
LAUREL, MD
ZIP 20707
Phone: (202) 723-4448

The NPI 1760786172 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/28/2010 and was last updated on 12/28/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	C0003952	MARYLAND	No
2	363AM0700X	Physician Assistant	Medical	PA030586	DISTRICT OF COLUMBIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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