Provider Demographics
NPI:1467949305
Name:VYAS, VRINDA (MBBS)
Entity type:Individual
Prefix:
First Name:VRINDA
Middle Name:
Last Name:VYAS
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1935
Mailing Address - Country:US
Mailing Address - Phone:252-823-2105
Mailing Address - Fax:
Practice Address - Street 1:101 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1935
Practice Address - Country:US
Practice Address - Phone:252-823-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA174170207RC0000X
NC2023-03014207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease