Provider Demographics
NPI:1679288583
Name:DAMENE, DEREJE (MEDICAL DRIVER)
Entity Type:Individual
Prefix:
First Name:DEREJE
Middle Name:
Last Name:DAMENE
Suffix:
Gender:M
Credentials:MEDICAL DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 MEYERFELD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-4810
Mailing Address - Country:US
Mailing Address - Phone:513-226-3152
Mailing Address - Fax:
Practice Address - Street 1:3876 MEYERFELD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-4810
Practice Address - Country:US
Practice Address - Phone:513-226-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)