Provider Demographics
NPI:1699208249
Name:WOLDEMESKEL, GASHAW
Entity Type:Individual
Prefix:
First Name:GASHAW
Middle Name:
Last Name:WOLDEMESKEL
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 1:5602 S BISCAY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5152
Mailing Address - Country:US
Mailing Address - Phone:303-995-7888
Mailing Address - Fax:
Practice Address - Street 1:5602 S BISCAY CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5152
Practice Address - Country:US
Practice Address - Phone:303-995-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO922549153172A00000X
CO051821200172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver