Healthcare Provider Details

I. General information

NPI: 1952198202
Provider Name (Legal Business Name): LUWAN TEKLE WELDESELASSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7144 GUYER AVE
PHILADELPHIA PA
19153-2406
US

IV. Provider business mailing address

7144 GUYER AVE
PHILADELPHIA PA
19153-2406
US

V. Phone/Fax

Practice location:
  • Phone: 202-509-3080
  • Fax:
Mailing address:
  • Phone: 202-509-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberMWG5335
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: