Provider Demographics
NPI:1023886819
Name:HAILE, ESUBALEW G
Entity type:Individual
Prefix:MR
First Name:ESUBALEW
Middle Name:G
Last Name:HAILE
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 1:444 N ARMISTEAD ST APT 104
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-3441
Mailing Address - Country:US
Mailing Address - Phone:202-207-7445
Mailing Address - Fax:
Practice Address - Street 1:444 N ARMISTEAD ST APT 104
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-3441
Practice Address - Country:US
Practice Address - Phone:202-207-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)