Provider Demographics
NPI:1295788685
Name:BAILEY, SHAWN CARROL (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:CARROL
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 DONNYLANE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-3228
Mailing Address - Country:US
Mailing Address - Phone:614-336-8380
Mailing Address - Fax:614-336-8557
Practice Address - Street 1:2975 DONNYLANE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-3228
Practice Address - Country:US
Practice Address - Phone:614-336-8380
Practice Address - Fax:614-336-8557
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2524414Medicaid
OHI19675Medicare UPIN
OHBA4145391Medicare ID - Type Unspecified