MEDICARE: DR. TEDLA ANBESSIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101058267	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00220778	OTHER	VA	RRMC
3	518598	OTHER	MD	NCPPO
4	K0520001	OTHER	DC	BC/BS DC

General Provider Information

NPI Number	:	1972590743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TEDLA ANBESSIE MD

Provider Business Mailing Address
First Line	:	85 S BRAGG ST STE 100
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2793
Country	:	US
Telephone Number	:	703-845-0057
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 S BRAGG ST STE 100
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2793
Country	:	US
Telephone Number	:	703-845-0700
Fax Number	:	703-794-2269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	11/13/2025

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