Provider Demographics
NPI:1528508009
Name:TEWELDEBRHAN, YOSEPH FISAHAYE (CRNP)
Entity type:Individual
Prefix:
First Name:YOSEPH
Middle Name:FISAHAYE
Last Name:TEWELDEBRHAN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 MAPLE AVE APT 1606
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5570
Mailing Address - Country:US
Mailing Address - Phone:202-758-5024
Mailing Address - Fax:
Practice Address - Street 1:10175 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2602
Practice Address - Country:US
Practice Address - Phone:410-375-7080
Practice Address - Fax:844-254-3216
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1023603363L00000X
MDR198411363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health