Provider Demographics
NPI:1972117281
Name:ENDALE, TESFAYE (TRANSPORTATION)
Entity Type:Individual
Prefix:MR
First Name:TESFAYE
Middle Name:
Last Name:ENDALE
Suffix:
Gender:M
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 EDMISTON WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3236
Mailing Address - Country:US
Mailing Address - Phone:202-361-6175
Mailing Address - Fax:
Practice Address - Street 1:1712 EDMISTON WAY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3236
Practice Address - Country:US
Practice Address - Phone:202-361-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB69802540347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker