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General NPI Number Information
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NPI Number | 1255529525
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Entity Type | Individual
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Provider Name | ELIAS TESSEMA M.D
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Gender | Male
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 500 J CLYDE MORRIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1929
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Country | US
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Telephone | 757-594-3455
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Fax |
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Provider Business Mailing Address
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Address Line | 117 MANHOAC RUN
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City | YORKTOWN
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State | VA
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Zip | 23693-2792
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Country | US
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Telephone | 757-597-3220
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 0101243571
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License Number State | VA
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