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General NPI Number Information
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NPI Number | 1538150339
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Entity Type | Individual
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Provider Name | DEREJE LEGESSE MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 8109 HINSON FARM ROAD, #504
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3427
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Country | US
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Telephone | 703-787-0280
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Fax | 703-778-0046
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Provider Business Mailing Address
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Address Line | 2101 E JEFFERSON ST
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101235106
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License Number State | VA
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