Provider Demographics
NPI:1487687521
Name:TESFALIDET, AZEB (MD)
Entity Type:Individual
Prefix:DR
First Name:AZEB
Middle Name:
Last Name:TESFALIDET
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 1:4215 BEAR CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841
Mailing Address - Country:US
Mailing Address - Phone:301-528-0592
Mailing Address - Fax:
Practice Address - Street 1:110 BAUGHMANS LN
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4059
Practice Address - Country:US
Practice Address - Phone:301-846-0300
Practice Address - Fax:601-663-6048
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
82098802OtherCAREFIRST MARYLAND
MD0403346Medicaid
1980256OtherUNITED HEALTHCARE
7037238OtherAETNA PPO
0074OtherCAREFIRST DC
286275OtherMAMSI
25804046OtherAETNA HMO
70519OtherNCPPO
112468OtherCOVENTRY
8470OtherKAISER
9628375001OtherCIGNA
MD93102Medicaid
039451OtherJOHNS HOPKINS HEALTHCARE
25804046OtherAETNA HMO
0074OtherCAREFIRST DC
MD93102Medicaid