Active NPI
Yonatan Sertsu, PHARMD
- Pharmacist
- Colmar Manor, MD
National Provider Identifier
1962819151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 21034
- Practice address
- 3611 Bladensburg Rd
Colmar Manor, MD 20722-1809 - Phone
- (301) 277-6667
- NPI assigned
- Jul 19, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 21034 | MD | Primary |
Addresses
Primary practice location
3611 Bladensburg Rd
Colmar Manor, MD 20722-1809
Mailing address
3611 Bladensburg Rd
Colmar Manor, MD 20722-1809
Phone (301) 277-6667
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21034 | Other | MD | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21034 | MD | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1962819151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3611 BLADENSBURG RD",
"city": "COLMAR MANOR",
"state": "MD",
"postal_code": "207221809",
"telephone_number": "301-277-6667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3611 BLADENSBURG RD",
"city": "COLMAR MANOR",
"state": "MD",
"postal_code": "207221809",
"telephone_number": "301-277-6667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERTSU",
"first_name": "YONATAN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-19",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "21034",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "21034",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colmar Manor, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.