Provider Demographics
NPI:1861459869
Name:WOLDESENBET, ELLENI (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLENI
Middle Name:
Last Name:WOLDESENBET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 SHADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-2724
Mailing Address - Country:US
Mailing Address - Phone:817-608-0625
Mailing Address - Fax:817-810-9815
Practice Address - Street 1:3132 MATLOCK RD
Practice Address - Street 2:SUITE #309
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2910
Practice Address - Country:US
Practice Address - Phone:817-417-0260
Practice Address - Fax:817-417-4834
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0707207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R0520OtherBLUE CROSS BLUE SHIELD
TX8R0520OtherBLUE CROSS BLUE SHIELD
TXH14818Medicare UPIN