Provider Demographics
NPI:1033168554
Name:TEWOLDEMEDIN, HINTSA (MD)
Entity Type:Individual
Prefix:
First Name:HINTSA
Middle Name:
Last Name:TEWOLDEMEDIN
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 1:42 MESSIMER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1842
Mailing Address - Country:US
Mailing Address - Phone:740-522-5641
Mailing Address - Fax:740-522-5642
Practice Address - Street 1:42 MESSIMER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1842
Practice Address - Country:US
Practice Address - Phone:740-522-5641
Practice Address - Fax:740-522-5642
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081394T207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2521775Medicaid
4141541Medicare ID - Type UnspecifiedMEDICARE
OH2521775Medicaid