Healthcare Provider Details

I. General information

NPI: 1972062024
Provider Name (Legal Business Name): EDEN HAILE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 ARLINGTON BLVD STE 200
FALLS CHURCH VA
22042-2336
US

IV. Provider business mailing address

3020 14TH ST NW
WASHINGTON DC
20009-6865
US

V. Phone/Fax

Practice location:
  • Phone: 703-531-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0210001333
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102207725
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: