Provider Demographics
NPI:1891793642
Name:RAJAN, VIJAY
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:
Last Name:RAJAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 MACK RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5373
Mailing Address - Country:US
Mailing Address - Phone:513-829-1700
Mailing Address - Fax:513-829-5333
Practice Address - Street 1:2960 MACK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5373
Practice Address - Country:US
Practice Address - Phone:513-829-1700
Practice Address - Fax:513-829-5333
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0573382084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0708434Medicaid
OH0617975Medicare PIN
OH0708434Medicaid
OHH215290Medicare PIN