Provider Demographics
NPI:1134742695
Name:DURA INTERNAL MEDICINE LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:DURA INTERNAL MEDICINE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FISEHATSION
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-778-4411
Mailing Address - Street 1:2315 HENSLOWE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2951
Mailing Address - Country:US
Mailing Address - Phone:240-778-4411
Mailing Address - Fax:
Practice Address - Street 1:15225 SHADY GROVE RD STE 103
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3252
Practice Address - Country:US
Practice Address - Phone:240-778-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty