Provider Demographics
NPI:1558464503
Name:MEZGHEBE, HAILE M (MD)
Entity Type:Individual
Prefix:
First Name:HAILE
Middle Name:M
Last Name:MEZGHEBE
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 1:3443 DICKERSON PIKE STE 370
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2535
Mailing Address - Country:US
Mailing Address - Phone:615-769-2799
Mailing Address - Fax:615-769-2798
Practice Address - Street 1:3443 DICKERSON PIKE STE 370
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2535
Practice Address - Country:US
Practice Address - Phone:615-769-2799
Practice Address - Fax:615-769-2798
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN503242086S0127X
DCMD147402086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409481600Medicaid
VA010020701Medicaid
DC027491700Medicaid
VA010020701Medicaid
B93393Medicare UPIN