Provider Demographics
NPI:1336276567
Name:DAGNEW, THEODROS (NP)
Entity Type:Individual
Prefix:DR
First Name:THEODROS
Middle Name:
Last Name:DAGNEW
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 WOODFIELD ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1872
Mailing Address - Country:US
Mailing Address - Phone:703-835-0827
Mailing Address - Fax:
Practice Address - Street 1:1700 17TH ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2453
Practice Address - Country:US
Practice Address - Phone:703-835-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNAT1000250175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNAT1000250OtherNATUROPATHY