Provider Demographics
NPI:1215798517
Name:WODAJO, MESERET
Entity type:Individual
Prefix:
First Name:MESERET
Middle Name:
Last Name:WODAJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 EDSALL RD APT M
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4184
Mailing Address - Country:US
Mailing Address - Phone:571-551-8745
Mailing Address - Fax:
Practice Address - Street 1:6151 EDSALL RD APT M
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4184
Practice Address - Country:US
Practice Address - Phone:571-551-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)