Healthcare Provider Details

I. General information

NPI: 1699612531
Provider Name (Legal Business Name): TILAHUN ANSHU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WHITTEMORE TER
ANDOVER MA
01810-1442
US

IV. Provider business mailing address

PO BOX 9461
LOWELL MA
01853-9461
US

V. Phone/Fax

Practice location:
  • Phone: 978-328-7277
  • Fax:
Mailing address:
  • Phone: 978-328-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number07109887
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: