Provider Demographics
NPI:1942566690
Name:VALLABH, JAYESH C (MD, MBA)
Entity Type:Individual
Prefix:
First Name:JAYESH
Middle Name:C
Last Name:VALLABH
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MEDICAL CENTER DR
Mailing Address - Street 2:1011 DODD HALL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1229
Mailing Address - Country:US
Mailing Address - Phone:614-293-4295
Mailing Address - Fax:614-293-3809
Practice Address - Street 1:480 MEDICAL CENTER DR
Practice Address - Street 2:1018 DODD HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-4295
Practice Address - Fax:614-293-3809
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129402208100000X
OH35129402208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.129402OtherSTATE LICENSE NUMBER