Provider Demographics
NPI:1649356304
Name:SARTAIN, MADELYN RENEE (DO)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:RENEE
Last Name:SARTAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:SARTAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3731
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-0374
Mailing Address - Country:US
Mailing Address - Phone:614-766-2220
Mailing Address - Fax:614-799-3023
Practice Address - Street 1:6810 PERIMETER DR
Practice Address - Street 2:STE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016
Practice Address - Country:US
Practice Address - Phone:614-766-2220
Practice Address - Fax:614-799-3023
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003964207QA0000X, 207QA0401X, 207QA0505X, 207QG0300X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0592729Medicaid
OH0592729Medicaid
OH4036861Medicare PIN