HAILELEOUL DESTA ERBELLO (NPI# 1760786172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760786172 |
| Entity Type | Individual |
| Full Name | HAILELEOUL DESTA ERBELLO |
| Credential | PA |
| Practice Address |
8118 Gorman Ave Apt # 104 Laurel MD 20707 |
| Mailing Address |
8118 Gorman Ave Apt 104 Laurel MD 20707-2536 |
| Practice Telephone | 2027234448 |
| Mailing Telephone | 2027234448 |
| Mailing Fax Number | 2027234494 |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2010-12-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
C0003952 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA030586 | DC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
8118 GORMAN AVE APT # 104 |
| City | LAUREL |
| State | MD |
| Zip Code | 20707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376157156 | Mini'imah Wilson | Social Worker | 15041 Cherrywood Dr, Laurel, MD 20707 | 2020-08-31 |
| 1548893985 | Ernest Freeman | Clinic/Center | 367 Main St., Laurel, Laurel, MD 20707 | 2020-02-13 |
| 1538701859 | Family Health and Wellness Clinic LLC | Clinic/Center | 324 Main St. #523, Laurel, MD 20707 | 2019-10-09 |
| 1467018226 | Leena Daniel | Nurse Practitioner | 13 C Street, Suite D, Laurel, MD 20707 | 2019-05-16 |
| 1538723143 | Florence Okojie | Nurse Practitioner | 13 C St Ste G, Laurel, MD 20707 | 2019-04-29 |
| 1487148631 | Munsha Sidhu Chadha | Dentist | 595 Main St Ste 237, Laurel, MD 20707 | 2018-06-20 |
| 1568953370 | Carleen Graham Schwimmer | Clinical Neuropsychologist | Veterans Affairs War Related Illness & Injury (wriisc), 50 Irving Street Nw, Washington, MD 20707 | 2018-05-29 |
| 1043709637 | Bk Behavioral Health Center | Behavior Technician | 14300 Cherry Lane Ct Ste 202-203, Laurel, MD 20707 | 2018-05-09 |
| 1053800839 | Bk Behaviorial Health Center | Substance Abuse Rehabilitation Facility | 14300 Cherry Lane Court, Suite 202-203, Laurel, MD 20707 | 2018-05-07 |
| 1316435795 | Laurel Pharmacy II LLC | Pharmacy | 14402 Baltimore Ave, Laurel, MD 20707 | 2018-05-01 |
| Find all providers in zip 20707 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780944892 | Shamane I Onwudiachi | Physician Assistant | 805 Washington Blvd S, Laurel, MD 20707-4611 | 2012-05-22 |
| 1710974290 | Dawn A. Adams | Physician Assistant | 7300 Van Dusen Rd, Laurel, MD 20707-9463 | 2005-09-30 |
| 1720441355 | Tiffany Edwards Keith | Physician Assistant | 1220 Jefferson St, Laurel, MS 39440-4355 | 2016-03-31 |
| 1386018414 | Eric Christopher Huber | Physician Assistant | 3357b Corridor Marketplace, Laurel, MD 20724-2381 | 2015-12-01 |
| 1740675487 | Alan Bryson | Physician Assistant | 1440 Jefferson St, Laurel, MS 39440-4243 | 2015-03-31 |
| 1942549027 | Olabisi Oladapo | Physician Assistant | 3357b Corridor Marketplace, Laurel, MD 20724-2381 | 2013-02-08 |
| 1992058556 | Dylan Paul Wagner | Physician Assistant | 2313 Highway 15 N, Laurel, MS 39440-1805 | 2012-10-19 |
| 1710127741 | Emerson Yang Chang | Physician Assistant | 7350 Van Dusen Rd, Suite 130, Laurel, MD 20707-5263 | 2009-03-03 |
| 1558522334 | Amy Elaine Reisman | Physician Assistant | 7300 Van Dusen Rd, Laurel, MD 20707-9463 | 2008-06-24 |
| 1740294669 | Beth L Pascal | Physician Assistant | 575 Main St, 351, Laurel, MD 20707-4343 | 2006-07-28 |
| Find all providers in LAUREL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.