Provider Demographics
NPI:1538426903
Name:HAILE-MICHAEL, MESELECH (LAC)
Entity type:Individual
Prefix:
First Name:MESELECH
Middle Name:
Last Name:HAILE-MICHAEL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 TUCKERMAN LN
Mailing Address - Street 2:#306
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-6639
Mailing Address - Country:US
Mailing Address - Phone:703-216-0667
Mailing Address - Fax:
Practice Address - Street 1:5204 TUCKERMAN LN
Practice Address - Street 2:#306
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-6639
Practice Address - Country:US
Practice Address - Phone:703-216-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500142171100000X
MDU01770171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist