Individual
KELEMEWORK KENTIBA WODIYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 TOWN CENTER DR, RESTON HOSPITAL, RESTON, VA 20190-3215
(510) 734-9037
Mailing address
1800 TOWN CENTER, RESTON, VA 20190
(510) 734-9037
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101247574
VA
208M00000X
Hospitalist Physician
0101247574
VA
Other
Enumeration date
12/05/2008
Last updated
08/11/2020
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