Bruke Tadesse

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

LC0295 Issued in MD

Practice address

3415 Hamilton St Ste 9
Hyattsville, MD 20782

Phone

(301) 779-2461

Fax

(301) 779-6095

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Health Center

  • Specialist
  • Hyattsville, MD
  • NPI 1316126121

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official
• Family Health Center Inc.

  • Adult Mental Health Clinic/Center
  • W Hyattsville, MD
  • NPI 1174110266
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555113600000",
    "number": "1306861752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 HAMILTON ST STE 9",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207823953",
            "telephone_number": "301-779-2461",
            "fax_number": "301-779-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 HAMILTON ST STE 9",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "20782",
            "telephone_number": "301-779-2461",
            "fax_number": "301-779-6095"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16220 S Frederick Ave",
            "address_2": "suite 422",
            "address_purpose": "LOCATION",
            "city": "Gaithersburg",
            "state": "MD",
            "postal_code": "208774039",
            "country_code": "US",
            "telephone_number": "301-963-7222",
            "fax_number": "301-963-2616",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6 Montgomery Village Ave Ste 400",
            "address_purpose": "LOCATION",
            "city": "Gaithersburg",
            "state": "MD",
            "postal_code": "208793548",
            "country_code": "US",
            "telephone_number": "301-963-7222",
            "fax_number": "301-963-2616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TADESSE",
        "first_name": "BRUKE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2019-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "LC0295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316126121",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093750697",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Tabe
• Crei Therese Gicana Tabligan, PHARMD
• Doris Nfornje Tabu
• Nelson Ndah Tabu, HHA CERTIFICATE
• Alemgenet Tadege
• Sandra Anim Tadoh
• Bethel Tafari
• Sylvie Tagba
• Theodora Tagbo
• Ahmed Taguimdje

• Addiction (Substance Use Disorder) Psychologist in Hyattsville, MD
• Providers in Hyattsville, MD by specialty
• Addiction (Substance Use Disorder) Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2019; 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.