Healthcare Provider Details

I. General information

NPI: 1023901766
Provider Name (Legal Business Name): MARIA TSEGAYE GEBREYESUS MD, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5189
US

IV. Provider business mailing address

1401 SPRUCE ST APT 1903
PHILADELPHIA PA
19102-4641
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3326
  • Fax:
Mailing address:
  • Phone: 571-492-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMT234182
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: