Healthcare Provider Details

I. General information

NPI: 1881935294
Provider Name (Legal Business Name): MATTHEW VAJEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 E GALBRAITH RD STE 108
CINCINNATI OH
45236-6704
US

IV. Provider business mailing address

4750 E GALBRAITH RD STE 215
CINCINNATI OH
45236-6706
US

V. Phone/Fax

Practice location:
  • Phone: 513-936-0500
  • Fax: 513-936-0600
Mailing address:
  • Phone: 513-936-0500
  • Fax: 513-936-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number34011653
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: