Active NPI
Tesfaye Endale, TRANSPORTATION
- Transportation Broker
- Midlothian, VA
National Provider Identifier
1972117281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Transportation Broker
- License
- B69802540
- Practice address
- 1712 Edmiston Way
Midlothian, VA 23114-3236 - Phone
- (202) 361-6175
- NPI assigned
- Sep 3, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Transportation Broker | 347E00000X | B69802540 | VA | Primary |
Addresses
Primary practice location
1712 Edmiston Way
Midlothian, VA 23114-3236
Mailing address
1712 Edmiston Way
Midlothian, VA 23114-3236
Phone (202) 361-6175
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B69802540 | VA | MD | Transportation Broker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599091200000",
"number": "1972117281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1712 EDMISTON WAY",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231143236",
"telephone_number": "202-361-6175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1712 EDMISTON WAY",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231143236",
"telephone_number": "202-361-6175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENDALE",
"first_name": "TESFAYE",
"name_prefix": "Mr.",
"credential": "TRANSPORTATION",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-03",
"last_updated": "2020-09-03",
"certification_date": "2020-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "347E00000X",
"taxonomy_group": "",
"desc": "Transportation Broker",
"state": "VA",
"license": "B69802540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.