Provider Demographics
NPI:1275906265
Name:DAVE, VIHANG
Entity Type:Individual
Prefix:
First Name:VIHANG
Middle Name:
Last Name:DAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WEST RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2341
Mailing Address - Country:US
Mailing Address - Phone:410-823-6683
Mailing Address - Fax:410-823-7684
Practice Address - Street 1:110 WEST RD STE 201
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2341
Practice Address - Country:US
Practice Address - Phone:410-823-6683
Practice Address - Fax:410-823-7684
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038807225100000X
MD27811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist