Provider Demographics
NPI:1770397952
Name:LULSEGED, BELETECH TSEGAYE
Entity type:Individual
Prefix:
First Name:BELETECH
Middle Name:TSEGAYE
Last Name:LULSEGED
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 COLUMBIA RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3602
Mailing Address - Country:US
Mailing Address - Phone:301-768-6595
Mailing Address - Fax:202-588-8101
Practice Address - Street 1:1660 COLUMBIA RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3602
Practice Address - Country:US
Practice Address - Phone:301-768-6595
Practice Address - Fax:202-588-8101
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1018537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily