Provider Demographics
NPI:1851510382
Name:BALASUBRAMANIAN, VIJAYALAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYALAKSHMI
Middle Name:
Last Name:BALASUBRAMANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33333 STATION ST
Mailing Address - Street 2:UNIT 39514
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-9524
Mailing Address - Country:US
Mailing Address - Phone:440-232-6610
Mailing Address - Fax:440-232-7509
Practice Address - Street 1:12 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2819
Practice Address - Country:US
Practice Address - Phone:440-252-4130
Practice Address - Fax:440-252-4132
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine