MEDICARE: RODAS ESAYAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146N00000X	Basic Emergency Medical Technician		VA

General Provider Information

NPI Number	:	1033852728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODAS ESAYAS

Provider Business Mailing Address
First Line	:	5577 VINCENT GATE TER UNIT 1449
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2573
Country	:	US
Telephone Number	:	170-381-4330
Fax Number	:

Provider Business Practice Location Address
First Line	:	5577 VINCENT GATE TER UNIT 1449
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2573
Country	:	US
Telephone Number	:	703-814-3309
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	04/19/2022

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Directions to “ RODAS ESAYAS ” Practice Location

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