Provider Demographics
NPI:1306943618
Name:ZENA, EYASSU (MD)
Entity type:Individual
Prefix:DR
First Name:EYASSU
Middle Name:
Last Name:ZENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 VARNUM STREET, NE
Mailing Address - Street 2:ST. CATHERINE HALL/1ST FL/RM 102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2104
Mailing Address - Country:US
Mailing Address - Phone:202-854-4812
Mailing Address - Fax:202-854-7825
Practice Address - Street 1:1150 VARNUM ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2104
Practice Address - Country:US
Practice Address - Phone:202-854-4470
Practice Address - Fax:202-854-4471
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233763207L00000X
DCMD33911207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00635689OtherRAILROAD MEDICARE PTAN
DC130739YRNMedicare PIN