Provider Demographics
NPI:1083607089
Name:ABHYANKAR, VIVEK V (MD)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:V
Last Name:ABHYANKAR
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:400 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1644
Practice Address - Country:US
Practice Address - Phone:740-376-5000
Practice Address - Fax:740-376-5002
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.076795207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2384316Medicaid
WV3810013481Medicaid
OH000000592453OtherANTHEM
OH000000696924OtherANTHEM
OHP00703814OtherRRMCR
OH4136762Medicare PIN
WV4273501Medicare PIN
OH7418801Medicare PIN
H79735Medicare UPIN