Provider Demographics
NPI:1104875129
Name:VAIDYA, RAKESHCHANDRA SHANTILAL (MD)
Entity type:Individual
Prefix:DR
First Name:RAKESHCHANDRA
Middle Name:SHANTILAL
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAKESH
Other - Middle Name:
Other - Last Name:VAIDYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8137 RIESLING DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6715
Mailing Address - Country:US
Mailing Address - Phone:336-790-8884
Mailing Address - Fax:
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-554-0000
Practice Address - Fax:317-554-0093
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine