Provider Demographics
NPI:1023228855
Name:MEZGEBE HAILE MD, PA
Entity type:Organization
Organization Name:MEZGEBE HAILE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MEZGEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-345-1400
Mailing Address - Street 1:7525 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE T 5
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3509
Mailing Address - Country:US
Mailing Address - Phone:301-345-1400
Mailing Address - Fax:301-345-0793
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:SUITE T 5
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-345-1400
Practice Address - Fax:301-345-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty