Provider Demographics
NPI:1568613263
Name:BAZAN, SARA ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELLEN
Last Name:BAZAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ELLEN
Other - Last Name:VANASDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-566-9108
Mailing Address - Fax:614-566-8737
Practice Address - Street 1:393 E TOWN ST STE 116
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4799
Practice Address - Country:US
Practice Address - Phone:614-566-9108
Practice Address - Fax:614-566-5669
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2967759Medicaid
OH2967759Medicaid