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General NPI Number Information
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NPI Number | 1801855697
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Entity Type | Organization
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Legal Business Name | MAHTEME SELASSIE, MDPA
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 7910 WOODMONT AVE SUITE 460
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City | BETHESDA
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State | MD
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Zip | 20814-3002
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Country | US
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Telephone | 301-656-9520
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Fax | 301-718-3633
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Provider Business Mailing Address
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Address Line | 7910 WOODMONT AVE SUITE 460
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City | BETHESDA
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State | MD
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Zip | 20814-3002
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Country | US
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Telephone | 301-656-9520
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Fax | 301-718-3633
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAHTEME SELASSIE
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Credential | MD
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Telephone | 301-656-9520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | D0052686
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License Number State | MD
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