Provider Demographics
NPI:1720748213
Name:HAILE, SAMSON TEFERI
Entity Type:Individual
Prefix:
First Name:SAMSON
Middle Name:TEFERI
Last Name:HAILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7322 WESTMORE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-4266
Mailing Address - Country:US
Mailing Address - Phone:240-838-4297
Mailing Address - Fax:
Practice Address - Street 1:2001 15TH ST NW APT 709
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5867
Practice Address - Country:US
Practice Address - Phone:240-838-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant