Provider Demographics
NPI:1952573370
Name:TESSEMA, TEDLA T (MD)
Entity type:Individual
Prefix:
First Name:TEDLA
Middle Name:T
Last Name:TESSEMA
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Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1101 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4467
Mailing Address - Country:US
Mailing Address - Phone:540-741-2855
Mailing Address - Fax:540-741-2859
Practice Address - Street 1:1101 SAM PERRY BLVD
Practice Address - Street 2:SUITE 219
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4467
Practice Address - Country:US
Practice Address - Phone:540-741-2855
Practice Address - Fax:540-741-2859
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD0368242086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery