Provider Demographics
NPI:1699130088
Name:TADESSE, MARTA
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:TADESSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 METZEROTT RD APT 106
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3499
Mailing Address - Country:US
Mailing Address - Phone:240-645-8596
Mailing Address - Fax:
Practice Address - Street 1:1824 METZEROTT RD APT 106
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3499
Practice Address - Country:US
Practice Address - Phone:240-645-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide