Provider Demographics
NPI:1669533196
Name:TESFAYE, GABY (MD)
Entity type:Individual
Prefix:DR
First Name:GABY
Middle Name:
Last Name:TESFAYE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - Street 2:2101 E JEFFERSON ST PPQA MEDICARE COMPLAINCE UNIT 6 W
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:6525 BELCREST ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2003
Practice Address - Country:US
Practice Address - Phone:301-209-6250
Practice Address - Fax:301-209-6204
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD32381207R00000X
MDD0052555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G83185Medicare UPIN
011203M92Medicare ID - Type Unspecified