Provider Demographics
NPI:1043097694
Name:BEKELE, TESHALE M
Entity Type:Individual
Prefix:MR
First Name:TESHALE
Middle Name:M
Last Name:BEKELE
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 1:119 VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-3774
Mailing Address - Country:US
Mailing Address - Phone:240-615-0634
Mailing Address - Fax:
Practice Address - Street 1:119 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-3774
Practice Address - Country:US
Practice Address - Phone:240-615-0634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver