Basic Information
| Provider Information | |||||||||
| NPI: | 1831536309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEKLEMICHAEL | ||||||||
| FirstName: | TIGIST | ||||||||
| MiddleName: | GEBREGZIABHER | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 S HANOVER ST | ||||||||
| Address2: | DEPARTMENT OF INTERNAL MEDICINE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212251233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103503565 | ||||||||
| FaxNumber: | 4103540186 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 S HANOVER ST | ||||||||
| Address2: | DEPARTMENT OF INTERNAL MEDICINE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212251233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103503565 | ||||||||
| FaxNumber: | 4103540186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2013 | ||||||||
| LastUpdateDate: | 09/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0081712 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.