Provider Demographics
NPI:1174515548
Name:DAYAL, VIKRAM (MD)
Entity type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:
Last Name:DAYAL
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 1:1516 BROOKDALE CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6749
Mailing Address - Country:US
Mailing Address - Phone:304-725-6777
Mailing Address - Fax:304-728-3623
Practice Address - Street 1:207 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1613
Practice Address - Country:US
Practice Address - Phone:304-725-6777
Practice Address - Fax:304-728-3623
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-04-21
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
WV16223208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710261OtherMTN STATE BCBS
52157701OtherCAREFIRST BCBS
WV6000470Medicaid
82951OtherMAMSI
WV0073128000Medicaid
2648VOtherCAREFIRST BCBS
4523983OtherAETNA
WV001721230OtherMTN STATE BCBS
2648VOtherCAREFIRST BCBS
DA0678404Medicare ID - Type Unspecified