Provider Demographics
NPI:1376592790
Name:BALRAJ, VIJAYKUMAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYKUMAR
Middle Name:
Last Name:BALRAJ
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 1:2000 POLARIS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2108
Mailing Address - Country:US
Mailing Address - Phone:614-430-9697
Mailing Address - Fax:614-430-9837
Practice Address - Street 1:2000 POLARIS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2108
Practice Address - Country:US
Practice Address - Phone:614-430-9697
Practice Address - Fax:614-430-9837
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5706103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31172544900OtherWORKERS COMP
OH2219227Medicaid