MEDICARE: DR. TIGIST HAILU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	D0061065	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063415388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIGIST HAILU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 64250
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4250
Country	:	US
Telephone Number	:	410-502-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	4924 CAMPBELL BLVD
Second Line	:	STE 110
City	:	BALTIMORE
State	:	MD
Zip	:	21236-5908
Country	:	US
Telephone Number	:	443-442-2000
Fax Number	:	443-442-2018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/07/2013

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Directions to “ DR. TIGIST HAILU M.D.” Practice Location

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