Provider Demographics
NPI:1053623876
Name:TAFA, MULETA D (MD)
Entity type:Individual
Prefix:
First Name:MULETA
Middle Name:D
Last Name:TAFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2411 W BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5228
Mailing Address - Country:US
Mailing Address - Phone:410-601-9200
Mailing Address - Fax:410-601-8648
Practice Address - Street 1:2411 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5228
Practice Address - Country:US
Practice Address - Phone:410-601-9200
Practice Address - Fax:410-601-8648
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN57917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine