Provider Demographics
NPI:1184111874
Name:BARO, CHALTU GEBISSA
Entity type:Individual
Prefix:MRS
First Name:CHALTU
Middle Name:GEBISSA
Last Name:BARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MATTERHORN DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1714
Mailing Address - Country:US
Mailing Address - Phone:614-499-2096
Mailing Address - Fax:614-626-3702
Practice Address - Street 1:940 MATTERHORN DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1714
Practice Address - Country:US
Practice Address - Phone:614-499-2096
Practice Address - Fax:614-626-3702
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH824098469Medicaid