Haileleoul Desta Erbello, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA030586 Issued in DC

Practice address

8118 Gorman Ave
Apt # 104
Laurel, MD 20707

Phone

(202) 723-4448

NPI assigned

Dec 28, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medstar Medical Group II LLC

  • Internal Medicine Physician
  • Washington, DC
  • NPI 1376887844
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293494400000",
    "number": "1760786172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8118 GORMAN AVE APT 104",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207072536",
            "telephone_number": "202-723-4448",
            "fax_number": "202-723-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8118 GORMAN AVE",
            "address_2": "APT # 104",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "20707",
            "telephone_number": "202-723-4448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERBELLO",
        "first_name": "HAILELEOUL",
        "middle_name": "DESTA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-28",
        "last_updated": "2010-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "DC",
            "license": "PA030586",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0003952",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ernestine Mbi Enohmbi, RN, DNP, MSN, FNP-BC
• Joana Enow, HHA
• Ogochukwu Enyi, PMHNP-BC
• Michele Jacqueline Epps, PT
• Equillibrium Health Care Services LLC
• Edward Afolajuwon Erinle
• Kesena Eroraha, DPT
• Susan Worten Eroraha, PH.D.
• Adeola Esan
• Ukachi Daniel Esen, NP

• Medical Physician Assistant in Laurel, MD
• Providers in Laurel, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.