Provider Demographics
NPI:1861936072
Name:WODAJO, MAHLET I
Entity type:Individual
Prefix:
First Name:MAHLET
Middle Name:
Last Name:WODAJO
Suffix:I
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 1:43 K ST NW UNIT 316
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2980
Mailing Address - Country:US
Mailing Address - Phone:202-763-2247
Mailing Address - Fax:
Practice Address - Street 1:43 K ST NW UNIT 316
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2980
Practice Address - Country:US
Practice Address - Phone:202-763-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty