Provider Demographics
NPI:1659530509
Name:AMDEMICHAEL, EDEN TSEHAYE (MD)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:TSEHAYE
Last Name:AMDEMICHAEL
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 1:3449 WILKENS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5216
Mailing Address - Country:US
Mailing Address - Phone:667-234-2703
Mailing Address - Fax:
Practice Address - Street 1:3449 WILKENS AVE STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5216
Practice Address - Country:US
Practice Address - Phone:667-234-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5691208600000X
MDD0089186208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery