Provider Demographics
NPI:1356702674
Name:MEHARU, TIGIST LEGESSE
Entity type:Individual
Prefix:
First Name:TIGIST
Middle Name:LEGESSE
Last Name:MEHARU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 MANCHESTER RD # APP.402
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4359
Mailing Address - Country:US
Mailing Address - Phone:202-813-5634
Mailing Address - Fax:
Practice Address - Street 1:8401 MANCHESTER RD # APP.402
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4359
Practice Address - Country:US
Practice Address - Phone:202-813-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11844374U00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Yes374U00000XNursing Service Related ProvidersHome Health Aide