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General NPI Number Information
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NPI Number | 1952759375
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Entity Type | Individual
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Provider Name | BETHLEHEM A. KASSAYE D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 1601 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3425
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Country | US
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Telephone | 910-678-0100
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Fax | 910-678-0115
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Provider Business Mailing Address
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Address Line | 1601 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3425
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Country | US
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Telephone | 910-678-0100
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Fax | 910-678-0115
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0086961
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 217771
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License Number State | NC
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