Healthcare Provider Details

I. General information

NPI: 1427111962
Provider Name (Legal Business Name): AMANUEL FESSAHAYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 FORBES BLVD SUITE E
LANHAM MD
20706-4351
US

IV. Provider business mailing address

4230 FORBES BLVD STE E
LANHAM MD
20706-4399
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-5535
  • Fax: 301-577-5536
Mailing address:
  • Phone: 301-577-5535
  • Fax: 301-577-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD58616
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD58616
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: