Healthcare Provider Details

I. General information

NPI: 1386971927
Provider Name (Legal Business Name): ADDISU M. TEMESGEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10259 CABERY RD
ELLICOTT CITY MD
21042-1605
US

IV. Provider business mailing address

10259 CABERY RD
ELLICOTT CITY MD
21042-1605
US

V. Phone/Fax

Practice location:
  • Phone: 410-870-9380
  • Fax:
Mailing address:
  • Phone: 410-870-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD0069354
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD69354
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: