Provider Demographics
NPI:1104320258
Name:TESFAYE, EDEN (MD)
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:
Last Name:TESFAYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EDEN
Other - Middle Name:
Other - Last Name:GIRMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1330 S FAIR ST APT 1719
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7801 OLD BRANCH AVE STE 409
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1644
Practice Address - Country:US
Practice Address - Phone:301-868-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator