Healthcare Provider Details

I. General information

NPI: 1033670997
Provider Name (Legal Business Name): YAFET MAMO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR # ED3025C2
COLUMBUS OH
43205-2639
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-5315
  • Fax: 614-355-1597
Mailing address:
  • Phone: 614-722-5315
  • Fax: 614-355-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number35.154552
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number35.154552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: