MEDICARE: MAHELET MAMO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024174476	VA

General Provider Information

NPI Number	:	1881132439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHELET MAMO

Provider Business Mailing Address
First Line	:	1101 WILSON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-2211
Country	:	US
Telephone Number	:	703-338-9490
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 WILSON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-2211
Country	:	US
Telephone Number	:	703-338-9490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	12/02/2025

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Directions to “ MAHELET MAMO ” Practice Location

Language	Start Address	Practice Location

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