Provider Demographics
NPI:1558900365
Name:TEKLE, MERON T
Entity Type:Individual
Prefix:
First Name:MERON
Middle Name:T
Last Name:TEKLE
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 1:6357 64TH AVE APT F6
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1501
Mailing Address - Country:US
Mailing Address - Phone:202-702-4742
Mailing Address - Fax:
Practice Address - Street 1:6357 64TH AVE APT F6
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1501
Practice Address - Country:US
Practice Address - Phone:202-702-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant