Provider Demographics
NPI:1790555167
Name:MAMO, DAWIT PETROS
Entity Type:Individual
Prefix:
First Name:DAWIT
Middle Name:PETROS
Last Name:MAMO
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 1:2846 MARCELLUS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-8120
Mailing Address - Country:US
Mailing Address - Phone:720-345-7556
Mailing Address - Fax:
Practice Address - Street 1:2846 MARCELLUS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-8120
Practice Address - Country:US
Practice Address - Phone:720-345-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant