Healthcare Provider Details

I. General information

NPI: 1669639282
Provider Name (Legal Business Name): WOLDECHERKOS ABEBE SHIBESHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 12/13/2022
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST ST OFC
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

1840 AMHERST ST OFC
WINCHESTER VA
22601-2808
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-4334
  • Fax: 540-536-4333
Mailing address:
  • Phone: 540-536-4334
  • Fax: 540-536-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25315
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101257884
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: