Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101251331 | VA |
N | 111NI0900X | Internist | 0101251331 | VA |
N | 207R00000X | Internist | 59991 | WI |
N | 111NI0900X | Internist | 59991 | WI |
N | 207R00000X | Internist | D79362 | MD |
N | 111NI0900X | Internist | D79362 | MD |
N | 207R00000X | Internist | MD041448 | DC |
N | 111NI0900X | Internist | MD041448 | DC |
Y | 207RI0200X | Infectious Disease | 0101251331 | VA |
N | 207RI0200X | Infectious Disease | 59991 | WI |
NPI | 1013145887 |
---|---|
Provider Name | Fisseha Yitbarek Ghidey |
First Address | Hyattsville, MD 20781-1963 |
Second Address | Hyattsville, MD 20781 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1265485270 | (05) | VA |