Provider Demographics
NPI:1184893471
Name:VIJAY B BEHARI MD INC
Entity type:Organization
Organization Name:VIJAY B BEHARI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-394-7676
Mailing Address - Street 1:1700 EAST MARKET ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6625
Mailing Address - Country:US
Mailing Address - Phone:330-394-7676
Mailing Address - Fax:
Practice Address - Street 1:1700 EAST MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6625
Practice Address - Country:US
Practice Address - Phone:330-394-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182878Medicaid
OH0367524Medicare PIN