Provider Demographics
NPI:1619751021
Name:TEFERRA, GEDION B
Entity Type:Individual
Prefix:
First Name:GEDION
Middle Name:B
Last Name:TEFERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 LEHMAN RD UNIT 501
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45204-1831
Mailing Address - Country:US
Mailing Address - Phone:619-817-7349
Mailing Address - Fax:
Practice Address - Street 1:2680 LEHMAN RD UNIT 501
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45204-1831
Practice Address - Country:US
Practice Address - Phone:619-817-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver