Provider Demographics
NPI:1568466365
Name:VAIDYA, KEDARNATH A (MD)
Entity type:Individual
Prefix:
First Name:KEDARNATH
Middle Name:A
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4248
Mailing Address - Street 2:DEPT 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4248
Mailing Address - Country:US
Mailing Address - Phone:281-444-3278
Mailing Address - Fax:832-249-3861
Practice Address - Street 1:17350 ST LUKES WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4167
Practice Address - Country:US
Practice Address - Phone:281-444-3278
Practice Address - Fax:832-249-3861
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM3100207RC0000X, 207RI0011X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197962701Medicaid
TX00J21AOtherGROUP MEDICARE
H35083Medicare UPIN
TX8K9068Medicare PIN