Provider Demographics
NPI:1003893595
Name:MISTRY, VIJAY G (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:G
Last Name:MISTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 MAYFIELD RD # 425
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2299
Mailing Address - Country:US
Mailing Address - Phone:440-442-2040
Mailing Address - Fax:440-460-2807
Practice Address - Street 1:6770 MAYFIELD RD # 425
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-442-2040
Practice Address - Fax:440-460-2807
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042001207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0432928Medicaid
OH0711064OtherMEDICARE ID - TYPE UNSPECIFIED
OH0711064OtherMEDICARE ID - TYPE UNSPECIFIED