Provider Demographics
NPI:1639969843
Name:WOLDEAMANUEL, ERMIYAS
Entity type:Individual
Prefix:
First Name:ERMIYAS
Middle Name:
Last Name:WOLDEAMANUEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 S GLEBE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2516
Mailing Address - Country:US
Mailing Address - Phone:202-985-8627
Mailing Address - Fax:
Practice Address - Street 1:2252 S GLEBE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2516
Practice Address - Country:US
Practice Address - Phone:202-985-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program