Provider Demographics
NPI:1881935294
Name:VAJEN, MATTHEW (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:VAJEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 E GALBRAITH RD STE 215
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6706
Mailing Address - Country:US
Mailing Address - Phone:513-936-0500
Mailing Address - Fax:513-936-0600
Practice Address - Street 1:4760 E GALBRAITH RD STE 108
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6704
Practice Address - Country:US
Practice Address - Phone:513-936-0500
Practice Address - Fax:513-936-0600
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34011653207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0121110Medicaid