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General NPI Number Information
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NPI Number | 1083803787
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Entity Type | Organization
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Legal Business Name | ARLINGTON INFECTIOUS DISEASE ASSOCIATES, PA
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 3132 MATLOCK RD SUITE 309
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City | ARLINGTON
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State | TX
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Zip | 76015-2910
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Country | US
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Telephone | 817-417-0260
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Fax | 817-417-4834
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Provider Business Mailing Address
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Address Line | 2718 SHADOW WOOD DR
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City | ARLINGTON
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State | TX
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Zip | 76006-2724
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Country | US
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Telephone | 817-608-0625
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Fax | 817-810-9815
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELLENI WOLDESENBET
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Credential | M.D.
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Telephone | 817-417-0260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | L0707
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License Number State | TX
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