Provider Demographics
NPI:1992310791
Name:TESFAMICHAEL, EYOB
Entity type:Individual
Prefix:
First Name:EYOB
Middle Name:
Last Name:TESFAMICHAEL
Suffix:
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 1:8025 13TH ST APT 312
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5817
Mailing Address - Country:US
Mailing Address - Phone:202-793-9766
Mailing Address - Fax:
Practice Address - Street 1:8025 13TH ST APT 312
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5817
Practice Address - Country:US
Practice Address - Phone:202-793-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00185635Medicaid