Provider Demographics
NPI:1073752036
Name:AYALEW, TARIKU DAMTE (MD)
Entity Type:Individual
Prefix:
First Name:TARIKU
Middle Name:DAMTE
Last Name:AYALEW
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 1:225 SOUTH WHITING STREET APT 605
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:301-618-3772
Mailing Address - Fax:301-618-2986
Practice Address - Street 1:16000 JOHNSTON MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211
Practice Address - Country:US
Practice Address - Phone:301-618-3772
Practice Address - Fax:301-618-2986
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250064208M00000X, 207R00000X
MEMD18942208M00000X, 207R00000X
NMMD2011-0811208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist