Provider Demographics
NPI:1083803787
Name:ARLINGTON INFECTIOUS DISEASE ASSOCIATES, PA
Entity Type:Organization
Organization Name:ARLINGTON INFECTIOUS DISEASE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLENI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLDESENBET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-417-0260
Mailing Address - Street 1:2718 SHADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-2724
Mailing Address - Country:US
Mailing Address - Phone:817-608-0625
Mailing Address - Fax:817-810-9815
Practice Address - Street 1:3132 MATLOCK RD
Practice Address - Street 2:SUITE 309
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2910
Practice Address - Country:US
Practice Address - Phone:817-417-0260
Practice Address - Fax:817-417-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0707207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0094LZOtherBCBS OF TX
TXDC6184OtherRAILROAD MEDICARE
TX0094LZOtherBCBS OF TX
TX00757XMedicare PIN