Healthcare Provider Details

I. General information

NPI: 1568613263
Provider Name (Legal Business Name): SARA ELLEN BAZAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA ELLEN VANASDALE D.O.

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W BROAD ST
COLUMBUS OH
43204-3783
US

IV. Provider business mailing address

2300 W BROAD ST
COLUMBUS OH
43204-3783
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-2300
  • Fax: 614-645-2333
Mailing address:
  • Phone: 614-645-2300
  • Fax: 614-645-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34.009374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: