Basic Information
| Provider Information | |||||||||
| NPI: | 1396291480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZEWOLDI | ||||||||
| FirstName: | SELAM | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 VARNUM ST NE | ||||||||
| Address2: | ST CATHERINE'S HALL, ROOM 102 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200172107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028544069 | ||||||||
| FaxNumber: | 2028547825 | ||||||||
| Practice Location | |||||||||
| Address1: | 1160 VARNUM ST NE | ||||||||
| Address2: | ST CATHERINE'S HALL, SUITE 200 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200172107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028547074 | ||||||||
| FaxNumber: | 2028547470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA031251 | DC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.