Provider Demographics
NPI:1609141548
Name:GSILASSIE, TSEGA (PA-C)
Entity Type:Individual
Prefix:
First Name:TSEGA
Middle Name:
Last Name:GSILASSIE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PENNSYLVANIA AVE SE
Mailing Address - Street 2:STE 220
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4318
Mailing Address - Country:US
Mailing Address - Phone:202-506-1036
Mailing Address - Fax:202-506-1076
Practice Address - Street 1:650 PENNSYLVANIA AVE SE
Practice Address - Street 2:STE 220
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4318
Practice Address - Country:US
Practice Address - Phone:202-506-1036
Practice Address - Fax:202-506-1076
Is Sole Proprietor?:No
Enumeration Date:2012-03-10
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030892363AM0700X
VA0110003744363AM0700X
MDC04530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VV9146AMedicare UPIN