Provider Demographics
NPI:1427041995
Name:VAJNER, PAUL R (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:VAJNER
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 1:696 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3319
Mailing Address - Country:US
Mailing Address - Phone:330-725-2900
Mailing Address - Fax:
Practice Address - Street 1:696 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3319
Practice Address - Country:US
Practice Address - Phone:330-725-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP21721Medicare ID - Type UnspecifiedPSYCHOLOGIST