Basic Information
| Provider Information | |||||||||
| NPI: | 1992830293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEZABEH | ||||||||
| FirstName: | SHEWIT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3334 ROSE LN | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220424013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028779696 | ||||||||
| FaxNumber: | 2028779263 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 IRVING ST NW | ||||||||
| Address2: | SUITE NA 1177 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200102976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028779696 | ||||||||
| FaxNumber: | 2028779263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 08/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD30238 | DC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110214860 | 01 | DC | RAILROAD MED | OTHER | J8790001 | 01 | DC | BLUE SHIELD | OTHER | 343651901 | 05 | MD | MEDICAID | 75859902 | 01 | MD | BLUE SHIELD | OTHER | 027084200 | 05 | DC | MEDICAID |