Provider Demographics
NPI:1093029886
Name:TAYE MAKURIA, ADDISALEM (MD)
Entity Type:Individual
Prefix:
First Name:ADDISALEM
Middle Name:
Last Name:TAYE MAKURIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-7599
Mailing Address - Fax:202-444-3713
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-7599
Practice Address - Fax:202-444-3713
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039172208000000X, 207ZB0001X
NC2013-00065207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5922763Medicaid
NC1764MOtherBCBS NC
NCNCC072AMedicare PIN