Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101048004 | VA |
N | 111NI0900X | Internist | 0101048004 | VA |
N | 207RH0000X | Hematologist | 0101048004 | VA |
N | 207RH0003X | Hematology & Oncology | 0101048004 | VA |
NPI | 1316013501 |
---|---|
Provider Name | Dr. Isaias Tesfazion |
First Address | Rockville, MD 20852-4908 |
Second Address | Fairfax, VA 22033-3952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F54850 | (02) |