Healthcare Provider Details

I. General information

NPI: 1174515548
Provider Name (Legal Business Name): VIKRAM DAYAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date: 03/27/2006
Reactivation Date: 04/12/2006

III. Provider practice location address

207 E 5TH AVE
RANSON WV
25438-1613
US

IV. Provider business mailing address

1516 BROOKDALE CT
WINCHESTER VA
22601-6749
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-6777
  • Fax: 304-728-3623
Mailing address:
  • Phone: 304-725-6777
  • Fax: 304-728-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16223
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16223
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: