Provider Demographics
NPI:1396069985
Name:BERHANU, SAMRAWIT (MD)
Entity type:Individual
Prefix:
First Name:SAMRAWIT
Middle Name:
Last Name:BERHANU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMRAWIT
Other - Middle Name:
Other - Last Name:WOLDEAMLAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:2800 S SHIRLINGTON RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3601
Practice Address - Country:US
Practice Address - Phone:571-777-2410
Practice Address - Fax:571-777-2411
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256871207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology