Provider Demographics
NPI:1700763810
Name:HAILE, SAMUEL TEFERRA (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:TEFERRA
Last Name:HAILE
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 1:1612 BECONTREE LN # LANE3C
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4017
Mailing Address - Country:US
Mailing Address - Phone:571-525-4955
Mailing Address - Fax:
Practice Address - Street 1:1612 BECONTREE LN # LANE3C
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4017
Practice Address - Country:US
Practice Address - Phone:571-525-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter