Healthcare Provider Details

I. General information

NPI: 1548201312
Provider Name (Legal Business Name): DR. VAYWALA P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BALTIMORE BLVD
WESTMINSTER MD
21157-7098
US

IV. Provider business mailing address

12415 PRESERVE WAY
REISTERSTOWN MD
21136-3533
US

V. Phone/Fax

Practice location:
  • Phone: 410-848-2170
  • Fax: 410-848-8679
Mailing address:
  • Phone: 410-848-2170
  • Fax: 410-876-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NAYAN VAYWALA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-848-2170