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General NPI Number Information
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NPI Number | 1548292022
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Entity Type | Individual
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Provider Name | MYTHILY VANCHA MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 2401 RESEARCH BLVD STE 330
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City | ROCKVILLE
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State | MD
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Zip | 20850-6255
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Country | US
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Telephone | 301-686-8554
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Fax |
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Provider Business Mailing Address
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Address Line | 9602 DIXON ST
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City | LAUREL
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State | MD
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Zip | 20723-1925
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Country | US
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Telephone | 301-575-4755
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Fax | 301-238-7833
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0064760
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License Number State | MD
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