Individual
DR. BRUKE TADESSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3415 HAMILTON ST STE 9, HYATTSVILLE, MD 20782
(301) 779-2461
(301) 779-6095
Mailing address
3415 HAMILTON ST STE 9, HYATTSVILLE, MD 20782-3953
(301) 779-2461
(301) 779-6095
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
LC0295
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093750697
—
MD
05
—
1316126121
—
MD
Enumeration date
07/13/2006
Last updated
04/13/2019
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