Healthcare Provider Details

I. General information

NPI: 1669052429
Provider Name (Legal Business Name): DR. TIRSIT RETTA WOLDEYOHANES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 COLISEUM DR STE 445
HAMPTON VA
23666-5981
US

IV. Provider business mailing address

3001 HOSPITAL DR
CHEVERLY MD
20785-1189
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-2127
  • Fax:
Mailing address:
  • Phone: 301-618-3559
  • Fax: 301-618-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101281906
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101281906
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: