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General NPI Number Information
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NPI Number | 1134621170
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Entity Type | Individual
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Provider Name | HABTAMU TIGABU CRNP-PMH
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Gender | Male
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 706 E GUDE DR UNIT A
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City | ROCKVILLE
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State | MD
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Zip | 20850-8317
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Country | US
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Telephone | 240-490-0176
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Fax | 240-880-0261
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Provider Business Mailing Address
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Address Line | 10 SNUG HILL CT
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City | POTOMAC
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State | MD
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Zip | 20854-4053
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Country | US
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Telephone | 240-490-0176
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Fax | 240-880-0261
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | R214455
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0005X
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Taxonomy Name | Neurodevelopmental Disabilities Physician
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License Number | R214455
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R214455
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License Number State | MD
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