Provider Demographics
NPI:1568630846
Name:YARED T TADESSE MD LLC
Entity Type:Organization
Organization Name:YARED T TADESSE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER & PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:YARED
Authorized Official - Middle Name:T
Authorized Official - Last Name:TADESSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-681-3995
Mailing Address - Street 1:11120 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2633
Mailing Address - Country:US
Mailing Address - Phone:301-681-3995
Mailing Address - Fax:301-681-3803
Practice Address - Street 1:11120 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2633
Practice Address - Country:US
Practice Address - Phone:301-681-3995
Practice Address - Fax:301-681-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW12076618261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service