Provider Demographics
NPI:1588290290
Name:DESALEGN, SELAM MULUGETA
Entity type:Individual
Prefix:
First Name:SELAM
Middle Name:MULUGETA
Last Name:DESALEGN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SILVER SPRING AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4646
Mailing Address - Country:US
Mailing Address - Phone:240-615-0543
Mailing Address - Fax:
Practice Address - Street 1:1616 MARION ST NW APT 213
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3473
Practice Address - Country:US
Practice Address - Phone:202-468-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant