=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619110020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAWIT HEALTHCARE SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2009
-----------------------------------------------------
Last Update Date | 04/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2041 GEORGIA AVE NW SUITE 2322
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20060-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-865-1121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12905 CRICKMORE TRCE
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20720-4683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-805-4586
-----------------------------------------------------
Fax | 301-805-1505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DAWIT YOHANNES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 301-793-6563
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD034563
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------