Provider Demographics
NPI:1548259633
Name:BHAIRAPPA, VAIJANATH (MD)
Entity type:Individual
Prefix:DR
First Name:VAIJANATH
Middle Name:
Last Name:BHAIRAPPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DENNISON
Mailing Address - State:OH
Mailing Address - Zip Code:44621-1003
Mailing Address - Country:US
Mailing Address - Phone:740-922-0000
Mailing Address - Fax:740-922-0025
Practice Address - Street 1:820 N 3RD ST
Practice Address - Street 2:
Practice Address - City:DENNISON
Practice Address - State:OH
Practice Address - Zip Code:44621-1033
Practice Address - Country:US
Practice Address - Phone:740-922-7477
Practice Address - Fax:740-922-6362
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.076583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2156947Medicaid
OHBJ7274861Medicare ID - Type Unspecified
OHH18959Medicare UPIN