Individual
DR. FASIL MENGISTU TIRUNEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2501 PARKERS LN, ALEXANDRIA, VA 22306-3209
(703) 664-7000
(703) 664-7666
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101262114
VA
207R00000X
Internal Medicine Physician
D84198
MD
208M00000X
Hospitalist Physician
0101262114
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184042061
—
VA
Enumeration date
03/28/2014
Last updated
03/03/2021
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