Provider Demographics
NPI:1083644702
Name:VYAS, SUBHASH A (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:A
Last Name:VYAS
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:P.O. BOX 1599
Mailing Address - Street 2:22 1/2 WEST SECOND AVENUE
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-1599
Mailing Address - Country:US
Mailing Address - Phone:304-235-0222
Mailing Address - Fax:304-235-4343
Practice Address - Street 1:22 1/2 WEST SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3506
Practice Address - Country:US
Practice Address - Phone:304-235-0222
Practice Address - Fax:304-235-4343
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12356208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
001715853OtherMOUNTAIN STATE BCBS
0005337227OtherAETNA
WV0130944000Medicaid
WVB42543Medicare UPIN
0439324Medicare PIN
WV0439324Medicare PIN