Provider Demographics
NPI:1164302584
Name:ASGEDOM, ADHANOM HABTESLASSIE
Entity type:Individual
Prefix:
First Name:ADHANOM
Middle Name:HABTESLASSIE
Last Name:ASGEDOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2840
Mailing Address - Country:US
Mailing Address - Phone:252-514-9888
Mailing Address - Fax:252-514-2881
Practice Address - Street 1:2717 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2840
Practice Address - Country:US
Practice Address - Phone:252-514-9888
Practice Address - Fax:252-514-2881
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC305207363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health