Provider Demographics
NPI:1831564319
Name:GESESEW, TSEHAYE
Entity type:Individual
Prefix:
First Name:TSEHAYE
Middle Name:
Last Name:GESESEW
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 1:6023 TURNABOUT LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3058
Mailing Address - Country:US
Mailing Address - Phone:240-505-5328
Mailing Address - Fax:
Practice Address - Street 1:6023 TURNABOUT LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3058
Practice Address - Country:US
Practice Address - Phone:240-505-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05936363A00000X
MDC0005936208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant