Provider Demographics
NPI:1992830293
Name:BEZABEH, SHEWIT (MD)
Entity type:Individual
Prefix:
First Name:SHEWIT
Middle Name:
Last Name:BEZABEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4013
Mailing Address - Country:US
Mailing Address - Phone:202-877-9696
Mailing Address - Fax:202-877-9263
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:SUITE NA 1177
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2976
Practice Address - Country:US
Practice Address - Phone:202-877-9696
Practice Address - Fax:202-877-9263
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC110214860OtherRAILROAD MED
DCJ8790001OtherBLUE SHIELD
MD343651901Medicaid
MD75859902OtherBLUE SHIELD
DC027084200Medicaid
DCJ8790001OtherBLUE SHIELD
DC027084200Medicaid