Provider Demographics
NPI:1316082555
Name:VAIDYA, SHRIKANT K (MD)
Entity type:Individual
Prefix:DR
First Name:SHRIKANT
Middle Name:K
Last Name:VAIDYA
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:SUITE 016
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2031
Practice Address - Country:US
Practice Address - Phone:304-675-6060
Practice Address - Fax:304-675-5001
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13842174400000X
OH35.053340208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131036000Medicaid
WV001707383OtherMOUNTAIN STATE BCBS
OH0544987Medicaid
WVCH5937OtherRAILROAD MEDICARE
WVVA4042924Medicare PIN
WVVA4042921Medicare PIN
OH0544987Medicaid
WVVA4042922Medicare PIN
WVVA4042923Medicare PIN