Provider Demographics
NPI:1083828552
Name:ALEMU, TADELE WUNETE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:TADELE
Middle Name:WUNETE
Last Name:ALEMU
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 UPLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310
Mailing Address - Country:US
Mailing Address - Phone:703-313-8323
Mailing Address - Fax:
Practice Address - Street 1:300 ARMORY PLACE
Practice Address - Street 2:SUITE 3M
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-225-8615
Practice Address - Fax:410-462-5095
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant