Individual
BAMLAK ESHETEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3310 CIRCLE BROOK DR APT B, ROANOKE, VA 24018-8227
(571) 315-2059
Mailing address
3310 CIRCLE BROOK DR APT B, ROANOKE, VA 24018-8227
(571) 315-2059
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B65301584
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B65301584
ID
VA
Enumeration date
06/25/2021
Last updated
07/24/2021
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