Healthcare Provider Details

I. General information

NPI: 1396291480
Provider Name (Legal Business Name): SELAM ZEWOLDI-BELAI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE ST CATHERINE'S HALL, SUITE 200
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1160 VARNUM ST NE ST CATHERINE'S HALL, ROOM 102
WASHINGTON DC
20017-2107
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-7074
  • Fax: 202-854-7470
Mailing address:
  • Phone: 202-854-4069
  • Fax: 202-854-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA031251
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC06170
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: