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General NPI Number Information
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NPI Number | 1699612531
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Entity Type | Individual
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Provider Name | TILAHUN ANSHU
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Gender | Male
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 9 WHITTEMORE TER
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City | ANDOVER
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State | MA
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Zip | 01810-1442
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Country | US
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Telephone | 978-328-7277
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9461
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City | LOWELL
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State | MA
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Zip | 01853-9461
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Country | US
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Telephone | 978-328-7277
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 07109887
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License Number State | WA
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