Provider Demographics
NPI:1942467840
Name:SUDHIR G. BAJI, M.D. , INC.
Entity Type:Organization
Organization Name:SUDHIR G. BAJI, M.D. , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-394-4755
Mailing Address - Street 1:1700 E MARKET ST
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6625
Mailing Address - Country:US
Mailing Address - Phone:330-394-4755
Mailing Address - Fax:330-399-4602
Practice Address - Street 1:1700 E MARKET ST
Practice Address - Street 2:SUITE# 110
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6625
Practice Address - Country:US
Practice Address - Phone:330-394-4755
Practice Address - Fax:330-399-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-039458208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000129220OtherANTHEM BCBS
OH0308045Medicaid
OH0308045Medicaid
OHA75630Medicare UPIN