Fantahun Mulugeta Tedla P.A-C

NPI 1033548144 - Physician Assistant - 363AM0700X

NPI Details
NPI 1033548144
Gender Male
Enumeration Date 11/08/2013
Last Updated 12/01/2013
Entity Type Individual
Active Over 3 years ago
Practice Location
419 BROOKS ST
CHARLESTON WV, 25301-1811, US
Phone (304) 388-6004
Fax
Business Location
870 ROXALANA HILLS DR
DUNBAR WV, 25064-1954, US
Phone (206) 351-7883
Fax
Toxanomy
Taxonomy Code 363AM0700X
License State West Virginia
License Number 623
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According to our database, Fantahun Mulugeta Tedla P.A-C NPI is 1033548144, taxonomy code is 363AM0700X and license number is 623, license state is located at West Virginia. Fantahun Mulugeta Tedla P.A-C physically located at 419 Brooks St, Charleston WV, 25301-1811. NPI Number Fantahun Mulugeta Tedla P.A-C has the Individual type.

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1033548144 NPI number is provided on an as is basis without warranty of any kind. 1033548144 is maintained by the National Plan & Provider Enumeration System. The contents of Fantahun Mulugeta Tedla P.A-C are for informational purposes only.