Provider Demographics
NPI:1184867756
Name:BAILEY, ELLEN HUNTER (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:HUNTER
Last Name:BAILEY
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 1:5965 E BROAD ST STE 250
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1544
Mailing Address - Country:US
Mailing Address - Phone:614-627-1560
Mailing Address - Fax:614-627-1565
Practice Address - Street 1:5965 E BROAD ST
Practice Address - Street 2:SUITE #250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1562
Practice Address - Country:US
Practice Address - Phone:614-759-5060
Practice Address - Fax:614-759-5065
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.126517208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program