Individual
TEWODROS WODAJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 CENTRAL AVE SE, EMERGENCY MEDICINE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
(505) 841-1737
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2023-00927
NC
207P00000X
Emergency Medicine Physician
Primary
MD2024-0163
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/31/2020
Last updated
07/10/2024
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