Healthcare Provider Details

I. General information

NPI: 1306002449
Provider Name (Legal Business Name): KASSAHUN TEFERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 GEORGIA AVE NW
WASHINGTON DC
20001-4029
US

IV. Provider business mailing address

3422 GEORGIA AVE NW
WASHINGTON DC
20010-2592
US

V. Phone/Fax

Practice location:
  • Phone: 202-413-1092
  • Fax:
Mailing address:
  • Phone: 202-413-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QC1000X
TaxonomyChemistry Pathology Specialist/Technologist
License Number04213642
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number04213642
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: