Provider Demographics
NPI:1598388399
Name:VYATA, VISHRUTH REDDY (MBBS)
Entity Type:Individual
Prefix:
First Name:VISHRUTH
Middle Name:REDDY
Last Name:VYATA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N GREENE STREET
Mailing Address - Street 2:ROOM 214
Mailing Address - City:BALITMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-706-4771
Mailing Address - Fax:410-601-6308
Practice Address - Street 1:827 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:BALITMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-706-4771
Practice Address - Fax:410-601-6308
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program