Provider Demographics
NPI:1134621170
Name:TIGABU, HABTAMU (CRNP-PMH)
Entity type:Individual
Prefix:MR
First Name:HABTAMU
Middle Name:
Last Name:TIGABU
Suffix:
Gender:M
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SNUG HILL CT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4053
Mailing Address - Country:US
Mailing Address - Phone:240-490-0176
Mailing Address - Fax:240-880-0261
Practice Address - Street 1:706 E GUDE DR UNIT A
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8317
Practice Address - Country:US
Practice Address - Phone:240-490-0176
Practice Address - Fax:240-880-0261
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2144552084A0401X, 2084P0005X, 363LP0808X
MDR4185376K00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No376K00000XNursing Service Related ProvidersNurse's Aide