Healthcare Provider Details

I. General information

NPI: 1639737158
Provider Name (Legal Business Name): KRUTI VYAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 THOMAS JOHNSON DR STE E
FREDERICK MD
21702-4399
US

IV. Provider business mailing address

63 THOMAS JOHNSON DR STE E
FREDERICK MD
21702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-7600
  • Fax: 301-228-2500
Mailing address:
  • Phone: 301-694-7600
  • Fax: 301-228-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0093874
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: