Provider Demographics
NPI:1972744977
Name:SIM, VIMALA VYTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIMALA
Middle Name:VYTHA
Last Name:SIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S FRONT ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437973207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1584078OtherGATEWAY
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherGREATWEST HEALTHCARE
PA50087992OtherCAPITAL BLUECROSS (WH)
PAG920-0125/KDM4CUOtherCAREFIRST
PAP00768396OtherRAILROAD MEDICARE
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherINTERGROUP
PASI2122269OtherHIGHMARK BLUESHIELD
PA1972744977OtherHEALTH AMERICA
PA284947OtherUNISON
PA6023118OtherAETNA HMO
PA102342840 0001Medicaid
PA102342840 0002 (WH)Medicaid
PA25-1716306OtherDEVON HEALTH CARE
PA1007307260034OtherMEDICAID GROUP #
PA25-1716306OtherINFORMED
PA50087997OtherCAPITAL BLUECROSS
PAMD437973OtherPA MEDICAL LICENSE
PA867633OtherMEDICARE GROUP #
PA9926341OtherAETNA NON-HMO
PA120420410OtherDEPT OF LABOR
PA25-1716306OtherFIRST HEALTH
PA25-1716306OtherFIRST HEALTH
PA164270LN7Medicare PIN