Provider Demographics
NPI:1013947001
Name:VYAS, DARSHAN K (MD)
Entity Type:Individual
Prefix:
First Name:DARSHAN
Middle Name:K
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1758
Mailing Address - Country:US
Mailing Address - Phone:937-622-5051
Mailing Address - Fax:
Practice Address - Street 1:140 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1758
Practice Address - Country:US
Practice Address - Phone:937-622-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074228V207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5738569OtherAETNA
OH0150456Medicaid
OH040013269OtherRAILROAD MEDICARE
OH000000026571OtherANTHEM BLUE CROSS BLUE SH
OH2060700Medicaid
OH2032544Medicaid
OH272828193OtherTRI CARE
OHGA9277642Medicare ID - Type UnspecifiedGROUP NUMBER TROY
OHVY0862751Medicare ID - Type UnspecifiedSIDNEY OFFICE IND #
OHGA9277641Medicare ID - Type UnspecifiedGROUP # SIDNEY
OHG82607Medicare UPIN
OH000000026571OtherANTHEM BLUE CROSS BLUE SH