Provider Demographics
NPI:1093763823
Name:MENGESHA, TEFERI G (MD)
Entity Type:Individual
Prefix:
First Name:TEFERI
Middle Name:G
Last Name:MENGESHA
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:PO BOX 636316
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:614-451-8770
Mailing Address - Fax:614-451-2291
Practice Address - Street 1:2355 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4305
Practice Address - Country:US
Practice Address - Phone:614-367-1004
Practice Address - Fax:614-367-1055
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084770207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000342136OtherANTHEM
OH2502367Medicaid
OHP00190383OtherMEDICARE RAILROAD
OHP00190383OtherMEDICARE RAILROAD
OH4137192Medicare PIN