MEDICARE: DR. YARED T TADESSE 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	207R00000X	Internal Medicine Physician	D0059519	MD

General Provider Information

NPI Number	:	1407812662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YARED T TADESSE M.D

Provider Business Mailing Address
First Line	:	11120 NEW HAMPSHIRE AVE
Second Line	:	SUITE 407
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-2633
Country	:	US
Telephone Number	:	301-681-3995
Fax Number	:	301-681-3803

Provider Business Practice Location Address
First Line	:	11120 NEW HAMPSHIRE AVE
Second Line	:	SUITE 407
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-2633
Country	:	US
Telephone Number	:	301-681-3995
Fax Number	:	301-681-3803

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/08/2007

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