Provider Demographics
NPI:1295572675
Name:TADELE, ENGIDAWORK GASHAW (MD)
Entity type:Individual
Prefix:
First Name:ENGIDAWORK
Middle Name:GASHAW
Last Name:TADELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ENGIDAWORK
Other - Middle Name:KEBEDE
Other - Last Name:HUNDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BROOKDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-613-4000
Mailing Address - Fax:888-419-2656
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-613-4000
Practice Address - Fax:888-419-2656
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program