Healthcare Provider Details

I. General information

NPI: 1285258442
Provider Name (Legal Business Name): KIDIST TAMIRAT ARFICHO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CROSSROADS DR STE 100
OWINGS MILLS MD
21117-5484
US

IV. Provider business mailing address

10461 MILL RUN CIR STE 1020
OWINGS MILLS MD
21117-5544
US

V. Phone/Fax

Practice location:
  • Phone: 443-436-1100
  • Fax: 443-436-1500
Mailing address:
  • Phone: 443-436-1100
  • Fax: 443-436-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0107192
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: