Basic Information
| Provider Information | |||||||||
| NPI: | 1225033806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABHYANKAR | ||||||||
| FirstName: | VIJAY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 W MACPHAIL RD | ||||||||
| Address2: | STE 106 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108933169 | ||||||||
| FaxNumber: | 4106388915 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 NORTH AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210142303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108386434 | ||||||||
| FaxNumber: | 4108384250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 12/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | M13942 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 259541200 | 05 | MD | MEDICAID |