Provider Demographics
NPI:1740301621
Name:VYAS, NILESH A (MD)
Entity type:Individual
Prefix:MR
First Name:NILESH
Middle Name:A
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:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:
Practice Address - Street 1:8081 INNOVATION PARK DR STE 900
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-4100
Practice Address - Fax:571-472-4101
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102389207T00000X
MO2006007887207T00000X
MDD69761207T00000X
TNMD0000044881207T00000X
VA0101231842207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery