Provider Demographics
NPI:1982068094
Name:TADDESSE, ADERAJEW AMSALU (MD, MSC)
Entity type:Individual
Prefix:DR
First Name:ADERAJEW
Middle Name:AMSALU
Last Name:TADDESSE
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MICHAEL ST NE STE 205N
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1047
Mailing Address - Country:US
Mailing Address - Phone:404-712-2970
Mailing Address - Fax:
Practice Address - Street 1:615 MICHAEL ST NE STE 205N
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-6105
Practice Address - Country:US
Practice Address - Phone:617-732-7420
Practice Address - Fax:404-712-2970
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA291746207R00000X
GA83410207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine