Provider Demographics
NPI:1104324474
Name:DEBESAY, HAGOS WELDEGEBRIEL
Entity type:Individual
Prefix:
First Name:HAGOS
Middle Name:WELDEGEBRIEL
Last Name:DEBESAY
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 1:1339 INDIANOLA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-4815
Mailing Address - Country:US
Mailing Address - Phone:614-972-2100
Mailing Address - Fax:
Practice Address - Street 1:1339 INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-4815
Practice Address - Country:US
Practice Address - Phone:614-972-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3974208347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker