Basic Information
| Provider Information | |||||||||
| NPI: | 1619110020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAWIT HEALTHCARE SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12905 CRICKMORE TRCE | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207204683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018054586 | ||||||||
| FaxNumber: | 3018051505 | ||||||||
| Practice Location | |||||||||
| Address1: | 2041 GEORGIA AVE NW | ||||||||
| Address2: | SUITE 2322 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028651121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2009 | ||||||||
| LastUpdateDate: | 04/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | YOHANNES | ||||||||
| AuthorizedOfficialFirstName: | DAWIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3017936563 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD034563 | DC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4232 | 01 | MD | BRAVO ELDER HEALTH | OTHER | 035899600 | 05 | DC | MEDICAID | 401665301 | 05 | MD | MEDICAID | 118590 | 01 | DC | AMERIGROUP | OTHER | K595 0001 | 01 | MD | CAREFIRST BLUE CROSS BLUE SHIELD | OTHER |