Tesfaye D Fanta MD PLLC

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

200900231 Issued in NC

Legal business name

TESFAYE D FANTA MD PLLC

Practice address

910 W Harrison St
Reidsville, NC 27320-3324

Phone

(336) 342-9564

Fax

(336) 349-9723

NPI assigned

Jan 5, 2012

Last updated

Jan 5, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tesfaye Demissie Fanta, MDNPI 1174557128

Title

Owner

Phone

(336) 342-9564

Specialties & licenses 1

Addresses

Other identifiers 4

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tesfaye Demissie Fanta, MD

  • Internal Medicine Physician
  • Reidsville, NC
  • NPI 1174557128
  NPD Authorized official
• Gebreselassie W Nida, M.D. , FACE

  • Endocrinology, Diabetes & Metabolism Physician
  • Reidsville, NC
  • NPI 1346450657
  NPD (past)
• Demissie H Solomon

  • Primary Care Nurse Practitioner
  • Greensboro, NC
  • NPI 1548765167
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325721600000",
    "number": "1033489216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 W HARRISON ST",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273203324",
            "telephone_number": "336-342-9564",
            "fax_number": "336-349-9723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 W HARRISON ST",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273203324",
            "telephone_number": "336-342-9564",
            "fax_number": "336-349-9723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TESFAYE D FANTA MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-01-05",
        "status": "A",
        "authorized_official_last_name": "FANTA",
        "authorized_official_first_name": "TESFAYE",
        "authorized_official_middle_name": "DEMISSIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-342-9564",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NC",
            "license": "200900231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1066A",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1522X",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5911977",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891066A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Endocrinology, Diabetes & Metabolism Physician in Reidsville, NC
• Providers in Reidsville, NC by specialty
• Endocrinology, Diabetes & Metabolism Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.