Individual
DR. MELAKU AYALEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8439 LAKE MIST WAY, FAIRFAX STATION, VA 22039-2676
(703) 200-5422
Mailing address
8439 LAKE MIST WAY, FAIRFAX STATION, VA 22039-2676
(703) 200-5422
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0052560
MD
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
D0052560
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101055711
STATE MEDICAL LICENSE
VA
01
—
D0052560
STATE MEDICAL CERTIFICATE
MD
Enumeration date
01/15/2008
Last updated
07/24/2012
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