Provider Demographics
NPI:1053844969
Name:ESHETU, TSEDEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TSEDEY
Middle Name:
Last Name:ESHETU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TSEDEYNAWIT
Other - Middle Name:
Other - Last Name:ESHETU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 37189
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3189
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:9321 SANGER ST STE 203
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2720
Practice Address - Country:US
Practice Address - Phone:703-982-8390
Practice Address - Fax:703-982-8391
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101268842207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program