Provider Demographics
NPI:1962065433
Name:KABTAMU, WONDWOSSEN
Entity type:Individual
Prefix:MR
First Name:WONDWOSSEN
Middle Name:
Last Name:KABTAMU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 DUKE ST APT 1201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4540
Mailing Address - Country:US
Mailing Address - Phone:301-256-5525
Mailing Address - Fax:
Practice Address - Street 1:622 KEEFER PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2515
Practice Address - Country:US
Practice Address - Phone:301-256-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant