Healthcare Provider Details

I. General information

NPI: 1528761475
Provider Name (Legal Business Name): DAGMAWIT MAELAF D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EXECUTIVE CENTER PKWY
FREDERICKSBURG VA
22401-3100
US

IV. Provider business mailing address

1340 CENTRAL PARK BLVD STE 100
FREDERICKSBURG VA
22401-4940
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-3324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102210016
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: