Provider Demographics
NPI:1861432650
Name:VAYWALA, NAYAN (MD)
Entity type:Individual
Prefix:
First Name:NAYAN
Middle Name:
Last Name:VAYWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 PRESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3533
Mailing Address - Country:US
Mailing Address - Phone:410-848-2170
Mailing Address - Fax:410-876-2270
Practice Address - Street 1:1130 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7098
Practice Address - Country:US
Practice Address - Phone:410-848-2170
Practice Address - Fax:410-876-2270
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23443207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD716601000Medicaid
DCR5130001OtherCAREFIRST B/C B/S
MDLQ64VAOtherBLUE CROSS & BLUE SHEILD
MDLQ64VAOtherBLUE CROSS & BLUE SHEILD
MDB69819Medicare UPIN