Basic Information
| Provider Information | |||||||||
| NPI: | 1205222601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEGEGN | ||||||||
| FirstName: | NAHOM | ||||||||
| MiddleName: | ASRAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15723 40TH AVE W APT D206 | ||||||||
| Address2: | |||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980871459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063345916 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2041 GEORGIA AVE NW RM-5C26 | ||||||||
| Address2: | |||||||||
| City: | WASINGTON DC | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028656100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2015 | ||||||||
| LastUpdateDate: | 04/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 000000 | DC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.