Provider Demographics
NPI:1477012482
Name:WOLDE, MECHAL SHUME
Entity Type:Individual
Prefix:
First Name:MECHAL
Middle Name:SHUME
Last Name:WOLDE
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 1:50 HAWAII AVE NE APT 9
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4907
Mailing Address - Country:US
Mailing Address - Phone:202-491-7354
Mailing Address - Fax:
Practice Address - Street 1:50 HAWAII AVE NE APT 9
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4907
Practice Address - Country:US
Practice Address - Phone:202-491-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health