Provider Demographics
NPI:1164530085
Name:VAIDYA, TRINETRA (MD)
Entity Type:Individual
Prefix:
First Name:TRINETRA
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 1:1901 SE 18TH AVE
Mailing Address - Street 2:BUILDING # 400
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8215
Mailing Address - Country:US
Mailing Address - Phone:352-732-8905
Mailing Address - Fax:
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 531
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8985
Practice Address - Country:US
Practice Address - Phone:352-751-4885
Practice Address - Fax:352-751-5371
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94145207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42075OtherBC/BS
FL42075OtherBC/BS
H58086Medicare UPIN