Provider Demographics
NPI:1861693111
Name:DEMMEKE, TSEGA (MD)
Entity type:Individual
Prefix:DR
First Name:TSEGA
Middle Name:
Last Name:DEMMEKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENBELT RD
Mailing Address - Street 2:SUITE L-1
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2354
Mailing Address - Country:US
Mailing Address - Phone:301-345-1900
Mailing Address - Fax:301-345-7149
Practice Address - Street 1:6201 GREENBELT RD
Practice Address - Street 2:SUITE L 1
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:301-345-1900
Practice Address - Fax:301-345-7149
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052216208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD500120000Medicaid