Provider Demographics
NPI:1891872347
Name:HADISH, SHIMANGUS (MD)
Entity Type:Individual
Prefix:
First Name:SHIMANGUS
Middle Name:
Last Name:HADISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHIMANGUS
Other - Middle Name:GHEBREMESKEL
Other - Last Name:HADISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVE NW
Mailing Address - Street 2:STE 4308
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-595-3223
Mailing Address - Fax:202-865-2985
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-6711
Practice Address - Fax:202-865-6713
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD34040207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406640500Medicaid
VA010125324Medicaid
DC036354700Medicaid
VA010125324Medicaid
016192H13Medicare PIN