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General NPI Number Information
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NPI Number | 1285097683
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Entity Type | Organization
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Legal Business Name | SKYLINE MEDICAL CENTER INC
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 5276 DAWES AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1404
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Country | US
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Telephone | 571-777-8494
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Fax |
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Provider Business Mailing Address
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Address Line | 6005 WALHAVEN DR
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2621
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Country | US
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Telephone | 703-888-2850
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TESFAYE TETEMKE
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Credential | MD
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Telephone | 571-777-8494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101244617
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License Number State | VA
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