Provider Demographics
NPI:1063087252
Name:MANASSAS NEUROLOGY LLC
Entity type:Organization
Organization Name:MANASSAS NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREHIWOT
Authorized Official - Middle Name:D
Authorized Official - Last Name:TEMESGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-675-0149
Mailing Address - Street 1:10605 BUSICK CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3400
Mailing Address - Country:US
Mailing Address - Phone:301-675-0149
Mailing Address - Fax:
Practice Address - Street 1:7880 DONEGAN DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2869
Practice Address - Country:US
Practice Address - Phone:301-675-0149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty