Provider Demographics
NPI:1700935590
Name:VYAS, CHANDRA K (M D)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:K
Last Name:VYAS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 N CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5665
Mailing Address - Country:US
Mailing Address - Phone:336-676-4388
Mailing Address - Fax:336-419-0042
Practice Address - Street 1:1910 N CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5665
Practice Address - Country:US
Practice Address - Phone:336-676-4388
Practice Address - Fax:336-419-0042
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985141Medicaid
NCP00654542OtherRR MEDICARE
NC8985141Medicaid
NC211211DMedicare PIN
NC211211Medicare ID - Type Unspecified