Provider Demographics
NPI:1104888403
Name:BAGENSTOSE, ABNER H III (MD)
Entity type:Individual
Prefix:
First Name:ABNER
Middle Name:H
Last Name:BAGENSTOSE
Suffix:III
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 1:5223 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4700
Mailing Address - Country:US
Mailing Address - Phone:912-303-9355
Mailing Address - Fax:
Practice Address - Street 1:4830 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:STE C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2300
Practice Address - Country:US
Practice Address - Phone:614-459-4949
Practice Address - Fax:614-459-4951
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037450B207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0395620Medicaid
OH0395620Medicaid
OH0457622Medicare PIN