Rediat Tadesse

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL-00288 Issued in MD

Practice address

12213 Old Fort Rd
Fort Washington, MD 20744-2714

Phone

(571) 344-4809

NPI assigned

Sep 11, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1225864663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12213 OLD FORT RD",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207442714",
            "telephone_number": "571-344-4809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12213 OLD FORT RD",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207442714",
            "telephone_number": "571-344-4809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADESSE",
        "first_name": "REDIAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MD",
            "license": "AL-00288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Strategic Screening & Diagnostics, LLC
• Suburban Orthopaedic Total Joint and Sports Clinic, P.C.
• Suburban Orthopaedic,Total Joint and Sports Clinic,P.C.
• Rattanakorn Suksaby, OTR/L
• James Eugene Sullivan, D.D.S.
• Zenash Gizaw Tadesse
• Elizabeth Park Tanner, M.D.
• Danielle Tapsoba
• Kulumba Tarawalie, RPH
• Anthony Tate Jr.

• Assisted Living Facility in Fort Washington, MD
• Providers in Fort Washington, MD by specialty
• Assisted Living Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.