Healthcare Provider Details

I. General information

NPI: 1578008991
Provider Name (Legal Business Name): LENSE TESSEMA DURESSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THAMES VLY
IRMO SC
29063-2469
US

IV. Provider business mailing address

1 THAMES VLY
IRMO SC
29063-2469
US

V. Phone/Fax

Practice location:
  • Phone: 412-273-0996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number71872
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: