Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D0057228 | MD |
Y | 111NI0900X | Internist | D0057228 | MD |
NPI | 1003020439 |
---|---|
Provider Name | Dr. Yonas Sisay |
First Address | Alexandria, VA 22304-3075 |
Second Address | Baltimore, MD 21202-3707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |