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General NPI Number Information
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NPI Number | 1033311246
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Entity Type | Individual
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Provider Name | MICHAEL TESFAZION PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 2041 GEORGIA AVENUE
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City | WASHINGTON
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State | DC
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Zip | 20001
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Country | US
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Telephone | 202-865-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 18213 QUEEN ELIZABETH DR
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City | OLNEY
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State | MD
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Zip | 20832-1717
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Country | US
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Telephone | 301-366-8606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA030331
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License Number State | DC
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