Provider Demographics
NPI:1396767380
Name:WODAJO, FELASFA MULUGETA (MD)
Entity type:Individual
Prefix:DR
First Name:FELASFA
Middle Name:MULUGETA
Last Name:WODAJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3040 WILLIAMS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:571-350-8400
Mailing Address - Fax:703-940-8697
Practice Address - Street 1:8613 LEE HWY # 200N
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2171
Practice Address - Country:US
Practice Address - Phone:703-208-9390
Practice Address - Fax:703-280-9596
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101 236907207X00000X, 207X00000X
DCMD31692207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010124522Medicaid
MD4045602 01Medicaid
MD4045602 01Medicaid
DCP01488669Medicare PIN
H61344Medicare UPIN