Provider Demographics
NPI:1336255710
Name:TADDESSE-HEATH, LEKIDELU (MD)
Entity Type:Individual
Prefix:
First Name:LEKIDELU
Middle Name:
Last Name:TADDESSE-HEATH
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 1:2041 GEORGIA AVE NW
Mailing Address - Street 2:# 6101
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-6679
Mailing Address - Fax:202-865-3138
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-806-6306
Practice Address - Fax:202-806-7022
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33813207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403107500Medicaid
VA010026270Medicaid
DC035165600Medicaid
H99513Medicare UPIN
MD403107500Medicaid