Healthcare Provider Details

I. General information

NPI: 1386322808
Provider Name (Legal Business Name): PHORAM VYAS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 SHRADER RD
HENRICO VA
23294-4215
US

IV. Provider business mailing address

8135 FOREST LN # 515057
DALLAS TX
75230-2472
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-1953
  • Fax:
Mailing address:
  • Phone: 469-839-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301494
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: