Provider Demographics
NPI:1831122647
Name:NEGUSSIE, YEHEYIS TASSEW (MD)
Entity Type:Individual
Prefix:DR
First Name:YEHEYIS
Middle Name:TASSEW
Last Name:NEGUSSIE
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 1:13136 BRUSHWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1025
Mailing Address - Country:US
Mailing Address - Phone:301-565-3440
Mailing Address - Fax:301-565-3455
Practice Address - Street 1:8604 2ND AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3326
Practice Address - Country:US
Practice Address - Phone:301-565-3440
Practice Address - Fax:301-565-3455
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045471207R00000X
DC21540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC026730200Medicaid
MD200300700Medicaid
G41980Medicare UPIN
DC026730200Medicaid