Healthcare Provider Details

I. General information

NPI: 1366960379
Provider Name (Legal Business Name): WELDAY MESFIN TEKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 THORNROSE AVE APT 8 8
RICHMOND VA
23228-2322
US

IV. Provider business mailing address

7004 THORNROSE AVE APT 8
HENRICO VA
23228-4433
US

V. Phone/Fax

Practice location:
  • Phone: 202-288-2217
  • Fax: 202-288-2217
Mailing address:
  • Phone: 202-288-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: