Provider Demographics
NPI:1467442541
Name:VYAS, JATIN MAHESH (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:JATIN
Middle Name:MAHESH
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD,PHD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT STREET CLN 3
Practice Address - Street 2:BIGELOW TEACHING SERVICE - INPATIENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-3812
Practice Address - Fax:617-726-7416
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157272207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22336OtherBCBS MA
MA157272OtherTUFTS HEALTH PLAN
MA3208214Medicaid
MAA29819Medicare ID - Type Unspecified
MA3208214Medicaid