Healthcare Provider Details

I. General information

NPI: 1649582982
Provider Name (Legal Business Name): SISSAY S BEFIKADU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR FL 5
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

2300 OPITZ BLVD STE G-209
WOODBRIDGE VA
22191-3311
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3198
  • Fax: 757-388-4242
Mailing address:
  • Phone: 703-523-0611
  • Fax: 703-670-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101253749
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101253749
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: