Basic Information
| Provider Information | |||||||||
| NPI: | 1629630173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VYAS | ||||||||
| FirstName: | ARJUN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 HOKE FARM WAY | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170504101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146917885 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2140 FISHER RD | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170555122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176577458 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2019 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OT019584 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | OT019584 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | OS020937 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | FV1404134 | 01 | PA | DEA | OTHER |