Provider Demographics
NPI:1487746228
Name:TELAHUN, AZEB (MD)
Entity type:Individual
Prefix:
First Name:AZEB
Middle Name:
Last Name:TELAHUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9131 PISCATAWAY RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2508
Mailing Address - Country:US
Mailing Address - Phone:301-868-6700
Mailing Address - Fax:301-868-3017
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2508
Practice Address - Country:US
Practice Address - Phone:301-868-6700
Practice Address - Fax:301-868-3017
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0048069207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
808821Medicare ID - Type Unspecified
G08994Medicare UPIN