Provider Demographics
NPI:1366960379
Name:TEKA, WELDAY MESFIN
Entity type:Individual
Prefix:
First Name:WELDAY
Middle Name:MESFIN
Last Name:TEKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 THORNROSE AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-4433
Mailing Address - Country:US
Mailing Address - Phone:202-288-2217
Mailing Address - Fax:
Practice Address - Street 1:7004 THORNROSE AVE APT 8
Practice Address - Street 2:8
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2322
Practice Address - Country:US
Practice Address - Phone:202-288-2217
Practice Address - Fax:202-288-2217
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA64290907Medicaid