Provider Demographics
NPI:1538797774
Name:TADESSE, WONDWOSEN DEMISSIE (MD)
Entity type:Individual
Prefix:DR
First Name:WONDWOSEN
Middle Name:DEMISSIE
Last Name:TADESSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WVU NEUROLOGY
Mailing Address - Street 2:5TH FLOOR POC PO BOX 0782
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MARYLAND PRINCE GEORGE'S HOSPITAL CENTER
Practice Address - Street 2:DEPARTMENT OF MEDICINE 3001 HOSPITAL DRIVE 5TH FLOOR
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785
Practice Address - Country:US
Practice Address - Phone:301-618-2273
Practice Address - Fax:301-429-1949
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program