Provider Demographics
NPI:1629647383
Name:TEKLE, MEHRETU ZERAY
Entity Type:Individual
Prefix:
First Name:MEHRETU
Middle Name:ZERAY
Last Name:TEKLE
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 1:979 ROBERTS CT # 979
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-4690
Mailing Address - Country:US
Mailing Address - Phone:540-705-0575
Mailing Address - Fax:
Practice Address - Street 1:1751 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-2730
Practice Address - Country:US
Practice Address - Phone:540-705-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA