Provider Demographics
NPI:1669011011
Name:TADESE, YARED ALEMAYEHU
Entity Type:Individual
Prefix:
First Name:YARED
Middle Name:ALEMAYEHU
Last Name:TADESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 MILLS AVE NE # BE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2542
Mailing Address - Country:US
Mailing Address - Phone:703-582-6780
Mailing Address - Fax:
Practice Address - Street 1:2945 MILLS AVE NE # BE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2542
Practice Address - Country:US
Practice Address - Phone:703-582-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide