Individual
DR. TESFAYE DEMISSIE FANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
910 WEST HARRISON STREET, REIDSVILLE, NC 27320
(336) 342-9564
(336) 349-9723
Mailing address
910 WEST HARRISON STREET, REIDSVILLE, NC 27320
(336) 342-9564
(336) 349-9723
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9700943
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891066A
—
NC
Enumeration date
07/10/2006
Last updated
07/26/2012
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