Healthcare Provider Details

I. General information

NPI: 1396981361
Provider Name (Legal Business Name): DAWIT MIHRETIE WUBIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-4230
  • Fax: 540-536-2507
Mailing address:
  • Phone: 540-536-4230
  • Fax: 540-536-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number150204
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101246509
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD73365
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2011-01769
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: