Provider Demographics
NPI:1548221674
Name:BAEHREN, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BAEHREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-314-0500
Mailing Address - Fax:803-314-0501
Practice Address - Street 1:3016 LONGTOWN COMMONS DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7849
Practice Address - Country:US
Practice Address - Phone:803-314-0500
Practice Address - Fax:803-314-0501
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-5494207P00000X
SC16167207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4433745Medicaid
OH000000298686OtherANTHEM
OH0685478Medicaid
OH341960760030OtherCARESOURCE
OH000000372949OtherANTHEM
OH727141OtherBCHP
OHP00191087Medicare PIN
OHBA4091962Medicare PIN
OH341960760030OtherCARESOURCE
OH727141OtherBCHP
WVBA4091961Medicare PIN
WVBA4091961Medicare PIN