Provider Demographics
NPI:1083671085
Name:TESSEMA, BELAY ESHETE (MD)
Entity Type:Individual
Prefix:DR
First Name:BELAY
Middle Name:ESHETE
Last Name:TESSEMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BELAY
Other - Middle Name:TESSEMA
Other - Last Name:ESHETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1500 NORTH WESTWOOD BLVD
Mailing Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901
Mailing Address - Country:US
Mailing Address - Phone:573-686-4151
Mailing Address - Fax:
Practice Address - Street 1:150 DEBRA RD
Practice Address - Street 2:5200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5616
Practice Address - Country:US
Practice Address - Phone:423-893-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36345146D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant