Provider Demographics
NPI:1902884802
Name:HACKSHAW, DAWN S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:S
Last Name:HACKSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1864
Mailing Address - Country:US
Mailing Address - Phone:614-824-2546
Mailing Address - Fax:614-824-2549
Practice Address - Street 1:1910 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1864
Practice Address - Country:US
Practice Address - Phone:614-824-2546
Practice Address - Fax:614-824-2549
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067158208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0176992Medicaid
OH275193963051OtherCARESOURCE