Provider Demographics
NPI:1932310851
Name:YEHEYIS T. NEGUSSIE MD PC
Entity Type:Organization
Organization Name:YEHEYIS T. NEGUSSIE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEHEYIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:NEGUSSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-565-3440
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200300700Medicaid
DC026730200Medicaid
DC178749Medicare PIN
MD200300700Medicaid