Provider Demographics
NPI:1104886605
Name:DEBAETS, DEBBRA (MD)
Entity type:Individual
Prefix:
First Name:DEBBRA
Middle Name:
Last Name:DEBAETS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3464
Mailing Address - Country:US
Mailing Address - Phone:614-538-0527
Mailing Address - Fax:614-538-0530
Practice Address - Street 1:3650 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3464
Practice Address - Country:US
Practice Address - Phone:614-538-0527
Practice Address - Fax:614-538-0530
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036099207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398207Medicaid
OHDE0796161Medicare PIN
OHH008001Medicare PIN
OH0398207Medicaid