Provider Demographics
NPI:1164689055
Name:TEKLEYOHANNES, GIRMAY HAILE (MD)
Entity Type:Individual
Prefix:
First Name:GIRMAY
Middle Name:HAILE
Last Name:TEKLEYOHANNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GIRMAY
Other - Middle Name:HAILE
Other - Last Name:TEKLE-YOHANNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-1339
Practice Address - Country:US
Practice Address - Phone:570-271-6440
Practice Address - Fax:570-271-6602
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452613208000000X, 2080P0207X
OH35. 091188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics