Individual
KEFYALEW REGASSA GOBENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1493 PARSONS AVE, COLUMBUS, OH 43207-1230
(614) 882-4343
(614) 882-4664
Mailing address
1493 PARSONS AVE, COLUMBUS, OH 43207-1230
(614) 882-4343
(614) 882-4664
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.007279RX
OH
363AM0700X
Medical Physician Assistant
50.007279RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0467560
—
OH
Enumeration date
07/23/2020
Last updated
04/03/2025
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