Individual
MYTHILY VANCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2401 RESEARCH BLVD STE 330, ROCKVILLE, MD 20850-6255
(301) 686-8554
Mailing address
9602 DIXON ST, LAUREL, MD 20723-1925
(301) 575-4755
(301) 238-7833
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0064760
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000
—
MD
Enumeration date
07/07/2006
Last updated
05/30/2023
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