Healthcare Provider Details

I. General information

NPI: 1376545947
Provider Name (Legal Business Name): TAMRAT BEKELE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 FALL BROOK ST
CARBONDALE PA
18407-0000
US

IV. Provider business mailing address

165 FALL BROOK ST
CARBONDALE PA
18407-0000
US

V. Phone/Fax

Practice location:
  • Phone: 570-282-3151
  • Fax: 570-282-3231
Mailing address:
  • Phone: 570-282-3151
  • Fax: 570-282-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD065698L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: