Provider Demographics
NPI:1639737158
Name:VYAS, KRUTI (MD)
Entity type:Individual
Prefix:
First Name:KRUTI
Middle Name:
Last Name:VYAS
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 1:63 THOMAS JOHNSON DR STE E
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4399
Mailing Address - Country:US
Mailing Address - Phone:301-694-7600
Mailing Address - Fax:301-228-2500
Practice Address - Street 1:63 THOMAS JOHNSON DR STE E
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4399
Practice Address - Country:US
Practice Address - Phone:301-694-7600
Practice Address - Fax:301-228-2500
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0093874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine