Healthcare Provider Details

I. General information

NPI: 1275587461
Provider Name (Legal Business Name): ETHIOPIA TEFERRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/03/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW # 1R84
WASHINGTON DC
20060-6442
US

IV. Provider business mailing address

695 DUTCHESS TPKE SUITE 105
POUGHKEEPSIE NY
12603-6442
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-3610
  • Fax:
Mailing address:
  • Phone: 888-647-5979
  • Fax: 888-847-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number268900
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0052417
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD037036
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: