Healthcare Provider Details

I. General information

NPI: 1366025249
Provider Name (Legal Business Name): DAWIT AYALEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 LORTON STATION BLVD STE 270
LORTON VA
22079-4798
US

IV. Provider business mailing address

9010 LORTON STATION BLVD STE 270
LORTON VA
22079-4798
US

V. Phone/Fax

Practice location:
  • Phone: 540-898-6500
  • Fax: 540-834-0363
Mailing address:
  • Phone: 540-898-6500
  • Fax: 540-834-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0101285511
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101285511
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: