Provider Demographics
NPI:1528069952
Name:MISTRY, NIRAJ CHIMANBHAI (MD)
Entity type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:CHIMANBHAI
Last Name:MISTRY
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 1:125 E BROAD ST
Mailing Address - Street 2:STE 202
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6400
Mailing Address - Country:US
Mailing Address - Phone:440-329-7305
Mailing Address - Fax:440-329-7798
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6400
Practice Address - Country:US
Practice Address - Phone:440-329-7306
Practice Address - Fax:440-329-7798
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-075487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2102450Medicaid
OH2102450Medicaid
G84559Medicare UPIN
OH0864497Medicare PIN