Provider Demographics
NPI:1356617682
Name:HAILEMICHAEL, SOLOMON (LSA, CSA)
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:HAILEMICHAEL
Suffix:
Gender:M
Credentials:LSA, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8964 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2460
Mailing Address - Country:US
Mailing Address - Phone:703-505-1022
Mailing Address - Fax:703-455-9560
Practice Address - Street 1:12011 LEE JACKSON HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-505-1022
Practice Address - Fax:703-455-9560
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA16246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant