Provider Demographics
NPI:1225190168
Name:TIBEBU, ATITEGEB (MD)
Entity Type:Individual
Prefix:
First Name:ATITEGEB
Middle Name:
Last Name:TIBEBU
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:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5741
Mailing Address - Fax:301-627-1603
Practice Address - Street 1:6845 ELM ST STE 710
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3851
Practice Address - Country:US
Practice Address - Phone:703-205-2626
Practice Address - Fax:703-205-7323
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053643207R00000X
VA0101840610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine