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TESFAYE D FANTA MD PLLC
NPI 1033489216
Internal Medicine - Endocrinology, Diabetes & Metabolism in Reidsville, NC

Active since January 05, 2012CLIA 34D0954419 · Waiver
910 W HARRISON ST, REIDSVILLE, NC 27320(336) 342-9564(336) 349-9723 Get Directions Write a Review

NPPES record last updated: January 5, 2012. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Tesfaye D Fanta Md Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TESFAYE D FANTA MD PLLC (NPI 1033489216) is a healthcare organization registered as an endocrinology, diabetes & metabolism in Reidsville, North Carolina and active in the NPI registry since January 2012. The organization holds a CLIA Waiver certificate valid through November 24, 2026 and lists Tesfaye Demissie Fanta, Owner, as its authorized official.

NPPES Registry Identity

NPI1033489216
Entity TypeOrganization
Primary Taxonomy207RE0101X
Legal Business NameTESFAYE D FANTA MD PLLC
Location Address910 W HARRISON STReidsville, NC 27320-3324
Mailing Address910 W Harrison StReidsville, NC 27320-3324 · (336) 342-9564 · Fax (336) 349-9723
Phone(336) 342-9564
Fax(336) 349-9723
Organization SubpartNo
Authorized OfficialTesfaye Demissie FantaOwner · (336) 342-9564
Enumeration DateJanuary 5, 2012
✔ NPI 1033489216 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Endocrinology, Diabetes & MetabolismAllopathic & Osteopathic Physicians
Taxonomy Code207RE0101X
License✔ Licensed in NC · 200900231
Definition
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.
910 W HARRISON ST, Reidsville, NC 27320
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Other Identifiers 6

Other1522XNC · Bcbs
Medicaid891066ANC
Medicaid5911977NC
Medicare PIN2240802BNC
Other1066ANC · Bcbs
Medicare PIN2073533NC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D0954419

Tesfaye D Fanta MD · Reidsville, NC
Active · expires Nov 24, 2026
CLIA Number34D0954419
Laboratory TypePhysician Office
Certificate Effective DateNovember 25, 2024
Certificate Expiration DateNovember 24, 2026
Laboratory DirectorTesfaye D. Fanta MD
Laboratory Phone(336) 342-9564
Laboratory LocationTesfaye D Fanta MD910 West Harrison St, Reidsville, NC 27320
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tesfaye D Fanta MD PLLC's NPI number?

The NPI number for Tesfaye D Fanta MD PLLC is 1033489216. It was assigned to this organization in the NPPES registry on January 5, 2012.

Where is Tesfaye D Fanta MD PLLC located?

Tesfaye D Fanta MD PLLC is located at 910 W Harrison St, Reidsville, NC 27320. The listed phone number is (336) 342-9564.

What is Tesfaye D Fanta MD PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

Does Tesfaye D Fanta MD PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D0954419) is associated with this NPI, valid through November 24, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Tesfaye D Fanta MD PLLC was last updated on January 5, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.