Provider Demographics
NPI:1073504940
Name:WOLDEHER, GETACHEW (MD)
Entity type:Individual
Prefix:
First Name:GETACHEW
Middle Name:
Last Name:WOLDEHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 RICHMOND HWY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8331
Mailing Address - Country:US
Mailing Address - Phone:540-657-9191
Mailing Address - Fax:540-657-0986
Practice Address - Street 1:2712 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1733
Practice Address - Country:US
Practice Address - Phone:540-657-9191
Practice Address - Fax:540-657-0986
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010020441Medicaid
00V816M63Medicare ID - Type Unspecified
VA010020441Medicaid