Provider Demographics
NPI:1629431267
Name:TONWE, TETSOMA (MD)
Entity Type:Individual
Prefix:
First Name:TETSOMA
Middle Name:
Last Name:TONWE
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 1:22309 HOLLY OAK LN
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5453
Mailing Address - Country:US
Mailing Address - Phone:302-423-0679
Mailing Address - Fax:
Practice Address - Street 1:1011 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1201
Practice Address - Country:US
Practice Address - Phone:302-734-2444
Practice Address - Fax:302-493-5254
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0013563207Q00000X
DEC10013563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine