MEDICARE: DR. DAWN S HACKSHAW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35067158	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	275193963051	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1902884802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWN S HACKSHAW MD

Provider Business Mailing Address
First Line	:	1910 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1864
Country	:	US
Telephone Number	:	614-824-2546
Fax Number	:	614-824-2549

Provider Business Practice Location Address
First Line	:	1910 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1864
Country	:	US
Telephone Number	:	614-824-2546
Fax Number	:	614-824-2549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	07/10/2012

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