Healthcare Provider Details

I. General information

NPI: 1619940228
Provider Name (Legal Business Name): DEREJE ZEWDE HAILE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FIRST COLONIAL RD FL 1
VIRGINIA BEACH VA
23454-3002
US

IV. Provider business mailing address

1060 FIRST COLONIAL RD FL 1
VIRGINIA BEACH VA
23454-3002
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-2323
  • Fax: 757-827-2255
Mailing address:
  • Phone: 757-395-2323
  • Fax: 757-827-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101058970
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101058970
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: