Provider Demographics
NPI:1518469782
Name:GEMECHU, TIGIST D (MD)
Entity Type:Individual
Prefix:DR
First Name:TIGIST
Middle Name:D
Last Name:GEMECHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TIGIST
Other - Middle Name:D
Other - Last Name:GEMECHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:355 BARD AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1664
Mailing Address - Country:US
Mailing Address - Phone:718-818-2419
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1664
Practice Address - Country:US
Practice Address - Phone:718-818-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R0000X207R00000X
WI81229208M00000X
TXT3282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist