MEDICARE: DR. VIJAYKUMAR BALRAJ PHD

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	103T00000X	Psychologist	5706	OH
2	103G00000X	Clinical Neuropsychologist	5706	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31172544900	OTHER	OH	WORKERS COMP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	311725449	OTHER	OH	TAX ID

General Provider Information

NPI Number	:	1376592790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIJAYKUMAR BALRAJ PHD

Provider Business Mailing Address
First Line	:	8472 COTTER ST
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-7139
Country	:	US
Telephone Number	:	614-430-9697
Fax Number	:	614-430-9837

Provider Business Practice Location Address
First Line	:	8472 COTTER ST
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-7139
Country	:	US
Telephone Number	:	614-430-9697
Fax Number	:	614-430-9837

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	09/16/2024

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