Provider Demographics
NPI:1356731897
Name:GEBREGIORGIS, TSEGAYE DANIEL (MD)
Entity type:Individual
Prefix:
First Name:TSEGAYE
Middle Name:DANIEL
Last Name:GEBREGIORGIS
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 1:100 SENTARA CIR RM 2C
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5713
Mailing Address - Country:US
Mailing Address - Phone:757-984-7217
Mailing Address - Fax:757-984-7210
Practice Address - Street 1:100 SENTARA CIR RM 2C
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5713
Practice Address - Country:US
Practice Address - Phone:757-984-7217
Practice Address - Fax:757-984-7210
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.131839207R00000X, 207P00000X
VA0101262026208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist