Provider Demographics
NPI:1063495380
Name:VAIDYA, ASHWINI KAMATH (MD)
Entity Type:Individual
Prefix:MRS
First Name:ASHWINI
Middle Name:KAMATH
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ASHWINI
Other - Middle Name:R
Other - Last Name:KAMATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 52588
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74152-0588
Mailing Address - Country:US
Mailing Address - Phone:918-749-2261
Mailing Address - Fax:918-749-8712
Practice Address - Street 1:2121 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1409
Practice Address - Country:US
Practice Address - Phone:918-749-2261
Practice Address - Fax:918-749-8712
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23219207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749090BMedicaid
OKP00063251OtherRAILROAD MEDICARE
OK100749090BMedicaid
H91750Medicare UPIN