Provider Demographics
NPI:1184157109
Name:ASSEFA, DESSALEGN TECHANE I
Entity type:Individual
Prefix:MR
First Name:DESSALEGN
Middle Name:TECHANE
Last Name:ASSEFA
Suffix:I
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 1:5719 BARNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234
Mailing Address - Country:US
Mailing Address - Phone:804-878-5984
Mailing Address - Fax:804-658-4546
Practice Address - Street 1:5719 BARNWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-7711
Practice Address - Country:US
Practice Address - Phone:804-878-5984
Practice Address - Fax:804-658-4546
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA45/4069141146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic