Provider Demographics
NPI:1730835729
Name:TEFERA, EMENET
Entity type:Individual
Prefix:
First Name:EMENET
Middle Name:
Last Name:TEFERA
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 1:13706 BARKSDALE DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3494
Mailing Address - Country:US
Mailing Address - Phone:517-435-5779
Mailing Address - Fax:
Practice Address - Street 1:13706 BARKSDALE DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3494
Practice Address - Country:US
Practice Address - Phone:571-435-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAN15-674343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)