Provider Demographics
NPI:1457307837
Name:HAYNES, SVITLANA (MD)
Entity Type:Individual
Prefix:
First Name:SVITLANA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SVITLANA
Other - Middle Name:
Other - Last Name:COBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3555 OLENTANGY RIVER RD
Mailing Address - Street 2:STE. 1080
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3912
Mailing Address - Country:US
Mailing Address - Phone:614-268-8164
Mailing Address - Fax:614-268-8406
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:STE. 1080
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-268-8164
Practice Address - Fax:614-268-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083752207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2472757Medicaid
OHI06202Medicare UPIN
OH2472757Medicaid