Provider Demographics
NPI:1548757917
Name:MOGED, ZINASHWORK W
Entity Type:Individual
Prefix:
First Name:ZINASHWORK
Middle Name:W
Last Name:MOGED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 SHEPHERD ST NW # NA
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5611
Mailing Address - Country:US
Mailing Address - Phone:202-509-1703
Mailing Address - Fax:
Practice Address - Street 1:824 UPSHUR ST NW # NA
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5837
Practice Address - Country:US
Practice Address - Phone:202-723-0755
Practice Address - Fax:202-723-0367
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13405374U00000X
DC13405374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4271314Medicaid