Provider Demographics
NPI:1902464001
Name:KASSIE, ADDIS GEREMEW (MD)
Entity Type:Individual
Prefix:
First Name:ADDIS
Middle Name:GEREMEW
Last Name:KASSIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9052 PICKWICK VILLAGE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3881
Mailing Address - Country:US
Mailing Address - Phone:240-845-4545
Mailing Address - Fax:
Practice Address - Street 1:9052 PICKWICK VILLAGE TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-3881
Practice Address - Country:US
Practice Address - Phone:240-845-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00162091163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty