Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 35.083935 | OH |
N | 208D00000X | General Practice Physician | 35.083935 | OH |
NPI | 1396955134 |
---|---|
Provider Name | Dr. Amanuel Ambaye Daniachew |
First Address | Worthington, OH 43085-2374 |
Second Address | Columbus, OH 43207-6023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 13/04/2021 |