Provider Demographics
NPI:1205222601
Name:TEGEGN, NAHOM ASRAT
Entity Type:Individual
Prefix:
First Name:NAHOM
Middle Name:ASRAT
Last Name:TEGEGN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15723 40TH AVE W APT D206
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-1459
Mailing Address - Country:US
Mailing Address - Phone:206-334-5916
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVE NW RM-5C26
Practice Address - Street 2:
Practice Address - City:WASINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC000000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine