Provider Demographics
NPI:1114527876
Name:VAITILINGAM, BALASUBRAMANIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BALASUBRAMANIAN
Middle Name:
Last Name:VAITILINGAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6692 ROCKY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9382
Mailing Address - Country:US
Mailing Address - Phone:765-586-8001
Mailing Address - Fax:
Practice Address - Street 1:3579 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4008
Practice Address - Country:US
Practice Address - Phone:614-409-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist