Provider Demographics
NPI:1124367776
Name:ABRAHA, TILAHUN HAILE (MD)
Entity Type:Individual
Prefix:
First Name:TILAHUN
Middle Name:HAILE
Last Name:ABRAHA
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 1:317 NINE BARK ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8709
Mailing Address - Country:US
Mailing Address - Phone:703-298-2838
Mailing Address - Fax:
Practice Address - Street 1:317 NINE BARK ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8709
Practice Address - Country:US
Practice Address - Phone:703-298-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602181252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology