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General NPI Number Information
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NPI Number | 1235552274
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Entity Type | Individual
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Provider Name | DANIEL TSIGE TAMERAT
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Gender | Male
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 07/24/2021
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Provider Practice Location Address
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Address Line | 5401 OLD COURT RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5103
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Country | US
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Telephone | 410-521-5950
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Fax |
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Provider Business Mailing Address
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Address Line | 5815 PRATT CT
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City | ALEXANDRIA
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State | VA
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Zip | 22310-1890
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Country | US
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Telephone | 240-476-1069
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C05298
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License Number State | MD
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