Provider Demographics
NPI:1619325446
Name:BAJAJ, VINAY V (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAY
Middle Name:V
Last Name:BAJAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S EAST AVE
Mailing Address - Street 2:UNIT GN
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2960
Mailing Address - Country:US
Mailing Address - Phone:515-771-0090
Mailing Address - Fax:
Practice Address - Street 1:250 S. 21ST STREET
Practice Address - Street 2:EASTON HOSPITAL
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-250-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211105208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT211105OtherMEDICAL TRAINING LICENSE