Provider Demographics
NPI:1033108808
Name:WOLDEHIWOT, GIZAW HAILE (MD)
Entity Type:Individual
Prefix:DR
First Name:GIZAW
Middle Name:HAILE
Last Name:WOLDEHIWOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5075 SPRINGHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3355
Mailing Address - Country:US
Mailing Address - Phone:410-238-1824
Mailing Address - Fax:410-601-2924
Practice Address - Street 1:2434 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5202
Practice Address - Country:US
Practice Address - Phone:410-601-2246
Practice Address - Fax:410-601-2924
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH330L954Medicare ID - Type Unspecified
MDI36784Medicare UPIN