Provider Demographics
NPI:1861437105
Name:NILE HEALTHCARE
Entity type:Organization
Organization Name:NILE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TEDLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANBESSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-845-0700
Mailing Address - Street 1:4600 KING ST
Mailing Address - Street 2:SUITE 4E
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1277
Mailing Address - Country:US
Mailing Address - Phone:703-845-0700
Mailing Address - Fax:703-998-8115
Practice Address - Street 1:4600 KING ST
Practice Address - Street 2:SUITE 4E
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1277
Practice Address - Country:US
Practice Address - Phone:703-845-0700
Practice Address - Fax:703-998-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233011207R00000X
VA0101058267207R00000X
VA0101238116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty