Paulos Dereje Abebe, PA-C
Individual provider Active NPI Family Medicine Physician · Lansdowne, VA
NPI 1750127684 · NPPES record last updated Jul 15, 2024
Key facts
- NPI
- 1750127684
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0110010143 (VA)
- Practice address
- 19415 Deerfield Ave Ste 301
Lansdowne, VA 20176-8472 - Phone
- (571) 367-0000
- NPI assigned
- Jul 1, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250516000066 | VA | Practitioner - Physician Assistant | 8123546884 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Interoperability endpoints
- paulos.abebe.1@15876.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0110010143 | VA | Yes |
Addresses
Primary practice location
19415 Deerfield Ave Ste 301
Lansdowne, VA 20176-8472
Mailing address
44527 Fiery Skipper Ter
Ashburn, VA 20147-2550
Phone (571) 484-0328
Other providers in Lansdowne, VA
- A Wink and a Smile Denitst PLLC
- Chandra Adhikari
- Adult and Geriatric Psychiatry
- Ashley Aguirre
- Ali Al-Fakhri
- Allergy & Asthma Affiliates, Inc.
All providers in Lansdowne, VA · Family Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.