Provider Demographics
NPI:1427937176
Name:DIRES, GETACHEW MEHERETU
Entity type:Individual
Prefix:MR
First Name:GETACHEW
Middle Name:MEHERETU
Last Name:DIRES
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 1:56 GILLETTE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-2108
Mailing Address - Country:US
Mailing Address - Phone:860-460-7470
Mailing Address - Fax:860-460-7470
Practice Address - Street 1:56 GILLETTE ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2108
Practice Address - Country:US
Practice Address - Phone:860-460-7470
Practice Address - Fax:860-460-7470
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3837172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver