Healthcare Provider Details

I. General information

NPI: 1316147168
Provider Name (Legal Business Name): MR. AFEWORK YACOB TANTU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 EVARTS ST NE
WASHINGTON DC
20018-1430
US

IV. Provider business mailing address

7989 ALMEDA CT
LORTON VA
22079-2363
US

V. Phone/Fax

Practice location:
  • Phone: 202-845-1786
  • Fax:
Mailing address:
  • Phone: 202-845-1786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number1316
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: