Provider Demographics
NPI:1760084370
Name:ADAGISH, SAMERAWIT K
Entity Type:Individual
Prefix:
First Name:SAMERAWIT
Middle Name:K
Last Name:ADAGISH
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 1:410 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1911
Mailing Address - Country:US
Mailing Address - Phone:540-320-7863
Mailing Address - Fax:
Practice Address - Street 1:324 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-3938
Practice Address - Country:US
Practice Address - Phone:540-320-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11111571343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)