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General NPI Number Information
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NPI Number | 1073856969
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Entity Type | Individual
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Provider Name | ZURIASHWORK T DAMTEW PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 8118 GOOD LUCK RD DOCTORS COMMUNITY MEDICAL GROUP LLC
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City | LANHAM
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State | MD
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Zip | 20706-3574
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Country | US
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Telephone | 301-552-8031
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 418056 DOCTORS COMMUNITY MEDICAL GROUP LLC
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City | BOSTON
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State | MA
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Zip | 02241-8056
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Country | US
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Telephone | 301-552-8031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0005012
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA52058
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License Number State | CA
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