MEDICARE: DR. THOMAS ROBERT VAJEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	35 045937	OH
2	208M00000X	Hospitalist Physician	224438	NC
3	207P00000X	Emergency Medicine Physician	224438	NC

General Provider Information

NPI Number	:	1194755207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ROBERT VAJEN MD

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 PLATEAU ST
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-4200
Country	:	US
Telephone Number	:	828-488-2155
Fax Number	:	828-488-4039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	10/31/2018

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