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General NPI Number Information
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NPI Number | 1376954040
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Entity Type | Individual
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Provider Name | ADDIS G TSEGAYE MD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 7129 AUSTRIAN WAY APT/SUITE
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-5626
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Country | US
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Telephone | 614-556-5424
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 STANTONSBURG RD APT SUITE
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City | GREENVILLE
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State | NC
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Zip | 27834-2818
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Country | US
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Telephone | 252-744-1406
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Fax | 252-744-4243
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | TSEG-Z5FFDA
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License Number State | NC
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