Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 35081394T | OH |
NPI | 1033168554 |
---|---|
Provider Name | Hintsa Tewoldemedin |
First Address | Newark, OH 43055-1842 |
Second Address | Newark, OH 43055-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2521775 | (05) | OH |
I15023 | (02) | OH |