Provider Demographics
NPI:1144595695
Name:VIJ, MALTI (MD)
Entity Type:Individual
Prefix:
First Name:MALTI
Middle Name:
Last Name:VIJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5501
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:9313 S MASON MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8008
Practice Address - Country:US
Practice Address - Phone:513-584-6999
Practice Address - Fax:513-584-6998
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2018-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.099025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074529Medicaid
KY7100399250Medicaid
OHH136222Medicare PIN