Provider Demographics
NPI:1619110020
Name:DAWIT HEALTHCARE SERVICES PLLC
Entity Type:Organization
Organization Name:DAWIT HEALTHCARE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAWIT
Authorized Official - Middle Name:
Authorized Official - Last Name:YOHANNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-793-6563
Mailing Address - Street 1:12905 CRICKMORE TRCE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4683
Mailing Address - Country:US
Mailing Address - Phone:301-805-4586
Mailing Address - Fax:301-805-1505
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:SUITE 2322
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4232OtherBRAVO ELDER HEALTH
DC035899600Medicaid
MD401665301Medicaid
DC118590OtherAMERIGROUP
MDK595 0001OtherCAREFIRST BLUE CROSS BLUE SHIELD
MD401665301Medicaid