Provider Demographics
NPI:1427111962
Name:FESSAHAYE, AMANUEL (MD)
Entity type:Individual
Prefix:
First Name:AMANUEL
Middle Name:
Last Name:FESSAHAYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4230 FORBES BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4351
Mailing Address - Country:US
Mailing Address - Phone:301-577-5535
Mailing Address - Fax:301-577-5536
Practice Address - Street 1:4230 FORBES BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4351
Practice Address - Country:US
Practice Address - Phone:301-577-5535
Practice Address - Fax:301-577-5536
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD586162085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG86431Medicare UPIN