Healthcare Provider Details

I. General information

NPI: 1073752036
Provider Name (Legal Business Name): TARIKU DAMTE AYALEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2009
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DRIVE
ABINGDON VA
24211
US

IV. Provider business mailing address

225 SOUTH WHITING STREET APT 605
ALEXANDRIA VA
22304
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-3772
  • Fax: 301-618-2986
Mailing address:
  • Phone: 301-618-3772
  • Fax: 301-618-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101250064
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2013-00134
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD18942
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD2011-0811
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101250064
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2013-00134
License Number StateNC
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2011-0811
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD18942
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: