1487687521 NPI number — DR. AZEB TESFALIDET M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487687521 NPI number — DR. AZEB TESFALIDET M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TESFALIDET

Provider First Name:

AZEB

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1487687521

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/09/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

4215 BEAR CREEK DRIVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BOYDS

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

20841

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

301-528-0592

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

110 BAUGHMANS LN

Provider Second Line Business Practice Location Address:

SECOND FLOOR

Provider Business Practice Location Address City Name:

FREDERICK

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21702-4059

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

301-846-0300

Provider Business Practice Location Address Fax Number:

601-663-6048

Provider Enumeration Date:

07/09/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  D0054940 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 82098802 . This is a "CAREFIRST MARYLAND" identifier . This identifiers is of the category "OTHER".
• Identifier: 0403346 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 1980256 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 7037238 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 0074 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
• Identifier: 286275 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 25804046 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 70519 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 112468 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
• Identifier: 8470 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
• Identifier: 9628375001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 93102 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 039451 . This is a "JOHNS HOPKINS HEALTHCARE" identifier . This identifiers is of the category "OTHER".