Provider Demographics
NPI:1740410844
Name:VYAS, CHINMAY B (MD)
Entity Type:Individual
Prefix:MR
First Name:CHINMAY
Middle Name:B
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7255 OLD OAK BLVD STE C209
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3329
Mailing Address - Country:US
Mailing Address - Phone:440-816-2777
Mailing Address - Fax:440-816-5437
Practice Address - Street 1:7255 OLD OAK BLVD STE C209
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-816-2777
Practice Address - Fax:440-816-5437
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 . 098941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH162980Medicare UPIN