MEDICARE: MELATEWORK ASSEFA WOLLE MD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1396628566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELATEWORK ASSEFA WOLLE MD.

Provider Business Mailing Address
First Line	:	326 EAST, 148TH STREET, APT. 3C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451
Country	:	US
Telephone Number	:	646-806-9531
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 EAST, 149TH STREET
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451
Country	:	US
Telephone Number	:	718-579-5030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	01/29/2026

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