Provider Demographics
NPI:1720527385
Name:TESSEMA, ABEL (PA-C)
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:
Last Name:TESSEMA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18813 HERITAGE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-2812
Mailing Address - Country:US
Mailing Address - Phone:301-906-9651
Mailing Address - Fax:
Practice Address - Street 1:18813 HERITAGE HILLS DR
Practice Address - Street 2:
Practice Address - City:BROOKEVILLE
Practice Address - State:MD
Practice Address - Zip Code:20833-2812
Practice Address - Country:US
Practice Address - Phone:301-906-9651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006259363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant