Provider Demographics
NPI:1134473671
Name:MEDICALOFFICEOF DR TEFERA
Entity Type:Organization
Organization Name:MEDICALOFFICEOF DR TEFERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GIRMA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TEFERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-213-0716
Mailing Address - Street 1:9628 SLOWAY COAST DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2787
Mailing Address - Country:US
Mailing Address - Phone:703-587-9900
Mailing Address - Fax:
Practice Address - Street 1:2946 SLEEPY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2003
Practice Address - Country:US
Practice Address - Phone:703-213-0716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty