Provider Demographics
NPI:1801801634
Name:ASHBAUGH, KEITH ELDON (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ELDON
Last Name:ASHBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W MARTZ STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331
Mailing Address - Country:US
Mailing Address - Phone:937-548-1535
Mailing Address - Fax:937-548-3138
Practice Address - Street 1:5735 MEEKER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1186
Practice Address - Country:US
Practice Address - Phone:937-548-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0103119A2084P0800X
OH350499272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS243081000OtherMAGELLAN BEHAVIORAL HEALT
000000019441OtherANTHEM BCBS
OH0562154Medicaid
260020831OtherMEDICARE RR
31140631400OtherWORKMANS COMP
OH0562154Medicaid
260020831OtherMEDICARE RR
OHAH0758644Medicare PIN