Provider Demographics
NPI:1023596764
Name:TEGEGN, MISKER N SR
Entity type:Individual
Prefix:
First Name:MISKER
Middle Name:N
Last Name:TEGEGN
Suffix:SR
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 1:7608 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6402
Mailing Address - Country:US
Mailing Address - Phone:804-873-2477
Mailing Address - Fax:804-320-3190
Practice Address - Street 1:7608 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6402
Practice Address - Country:US
Practice Address - Phone:804-873-2477
Practice Address - Fax:804-320-3190
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver