Provider Demographics
NPI:1073654570
Name:VAIDYA, CHIRAG (MD)
Entity Type:Individual
Prefix:
First Name:CHIRAG
Middle Name:
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 1869
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1869
Mailing Address - Country:US
Mailing Address - Phone:909-981-5882
Mailing Address - Fax:909-946-0833
Practice Address - Street 1:1317 W FOOTHILL BLVD
Practice Address - Street 2:STE 148
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3676
Practice Address - Country:US
Practice Address - Phone:909-981-5882
Practice Address - Fax:909-946-0833
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233518207R00000X
CAA111164207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine