Provider Demographics
NPI:1992066468
Name:MOLLA, TSIGE T
Entity type:Individual
Prefix:
First Name:TSIGE
Middle Name:T
Last Name:MOLLA
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 1:5910 14TH ST NW
Mailing Address - Street 2:APT # 303
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1728
Mailing Address - Country:US
Mailing Address - Phone:202-677-1625
Mailing Address - Fax:
Practice Address - Street 1:5910 14TH ST NW
Practice Address - Street 2:APT # 303
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1728
Practice Address - Country:US
Practice Address - Phone:202-677-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide