Provider Demographics
NPI:1073856969
Name:DAMTEW, ZURIASHWORK T (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ZURIASHWORK
Middle Name:T
Last Name:DAMTEW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418056
Mailing Address - Street 2:DOCTORS COMMUNITY MEDICAL GROUP LLC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8056
Mailing Address - Country:US
Mailing Address - Phone:301-552-8031
Mailing Address - Fax:
Practice Address - Street 1:8118 GOOD LUCK RD
Practice Address - Street 2:DOCTORS COMMUNITY MEDICAL GROUP LLC
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3574
Practice Address - Country:US
Practice Address - Phone:301-552-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005012363AM0700X
CAPA52058363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA52058OtherLICENSE