Provider Demographics
NPI:1972252815
Name:HADUSH, LEMLEM MENGESHA
Entity type:Individual
Prefix:
First Name:LEMLEM
Middle Name:MENGESHA
Last Name:HADUSH
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 1:11341 COLUMBIA PIKE APT 68
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2539
Mailing Address - Country:US
Mailing Address - Phone:240-918-4557
Mailing Address - Fax:
Practice Address - Street 1:11341 COLUMBIA PIKE APT 68
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2539
Practice Address - Country:US
Practice Address - Phone:240-918-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00188814251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health