Healthcare Provider Details

I. General information

NPI: 1568918472
Provider Name (Legal Business Name): MESAY GEBRESILASSIE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 GRACEFIELD RD
SILVER SPRING MD
20904-1820
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 301-572-8340
  • Fax: 301-572-8403
Mailing address:
  • Phone: 410-402-2379
  • Fax: 410-469-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR196623
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR196623
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: