Provider Demographics
NPI:1487112462
Name:HAILE, MESFIN TEFERI SR
Entity type:Individual
Prefix:
First Name:MESFIN
Middle Name:TEFERI
Last Name:HAILE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 W GLEBE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-1463
Mailing Address - Country:US
Mailing Address - Phone:571-315-7446
Mailing Address - Fax:
Practice Address - Street 1:2001 15TH ST NW APT 718
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5869
Practice Address - Country:US
Practice Address - Phone:571-315-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant