Provider Demographics
NPI:1225033806
Name:ABHYANKAR, VIJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:
Last Name:ABHYANKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:615 W MACPHAIL RD
Mailing Address - Street 2:STE 106
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4393
Mailing Address - Country:US
Mailing Address - Phone:410-893-3169
Mailing Address - Fax:410-638-8915
Practice Address - Street 1:2 NORTH AVE
Practice Address - Street 2:STE 101
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2303
Practice Address - Country:US
Practice Address - Phone:410-838-6434
Practice Address - Fax:410-838-4250
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDM13942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259541200Medicaid
MDE16556Medicare UPIN
MD259541200Medicaid