Provider Demographics
NPI:1790861805
Name:DHYANCHAND, CHARLES JAYADEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JAYADEEP
Last Name:DHYANCHAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:JAYADEEP
Other - Last Name:DHYANCHAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1400 S ARLINGTON ST
Mailing Address - Street 2:ST. 38
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3750
Mailing Address - Country:US
Mailing Address - Phone:330-724-5471
Mailing Address - Fax:330-786-0108
Practice Address - Street 1:1400 S ARLINGTON ST
Practice Address - Street 2:ST. 38
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3750
Practice Address - Country:US
Practice Address - Phone:330-724-5471
Practice Address - Fax:330-786-0108
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70490Medicare UPIN