Healthcare Provider Details

I. General information

NPI: 1720527385
Provider Name (Legal Business Name): ABEL TESSEMA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON ROAD SUITE 5A43
NEWARK DE
19718-2200
US

IV. Provider business mailing address

18813 HERITAGE HILLS DR
BROOKEVILLE MD
20833-2812
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0188
  • Fax: 302-733-5640
Mailing address:
  • Phone: 301-906-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012098
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0006259
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: