Provider Demographics
NPI:1548144637
Name:WENDAFRASH, MESKEREM LULSEGED
Entity type:Individual
Prefix:
First Name:MESKEREM
Middle Name:LULSEGED
Last Name:WENDAFRASH
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 1:2531 PERCH LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5889
Mailing Address - Country:US
Mailing Address - Phone:571-224-6741
Mailing Address - Fax:
Practice Address - Street 1:10130 PERIMETER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0197
Practice Address - Country:US
Practice Address - Phone:571-224-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor