Healthcare Provider Details

I. General information

NPI: 1396150926
Provider Name (Legal Business Name): BINYAM GEBREMEDHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 01/25/2022
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MCKINLEY PARK DR
MARION OH
43302-6399
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-8883
  • Fax: 614-566-8149
Mailing address:
  • Phone: 614-566-8883
  • Fax: 614-566-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.130410
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.130410
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: