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General NPI Number Information
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NPI Number | 1881966851
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Entity Type | Organization
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Legal Business Name | SOLOMON FEYISSA LLC
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 14740 4TH ST APT 415
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City | LAUREL
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State | MD
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Zip | 20707-3718
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Country | US
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Telephone | 240-294-6536
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Fax | 240-294-7235
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Provider Business Mailing Address
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Address Line | 14740 4TH ST APT 415
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City | LAUREL
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State | MD
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Zip | 20707-3718
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Country | US
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Telephone | 240-294-6536
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Fax | 240-294-7235
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | DR. SOLOMON ALEMU FEYISSA
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Credential | M.D.
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Telephone | 240-294-6536
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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 | D070500
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License Number State | MD
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