Provider Demographics
NPI:1386837011
Name:TELAHUN, SHRADER & RIVERA, MD
Entity Type:Organization
Organization Name:TELAHUN, SHRADER & RIVERA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZEB
Authorized Official - Middle Name:
Authorized Official - Last Name:TELAHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-868-6700
Mailing Address - Street 1:9131 PISCATAWAY RD STE 450
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2543
Mailing Address - Country:US
Mailing Address - Phone:301-868-6700
Mailing Address - Fax:301-868-3017
Practice Address - Street 1:9131 PISCATAWAY RD STE 450
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2543
Practice Address - Country:US
Practice Address - Phone:301-868-6700
Practice Address - Fax:301-868-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD808821Medicare PIN
MD4980720001Medicare NSC