Provider Demographics
NPI:1245405034
Name:VIVEK C. VAID MD PA
Entity Type:Organization
Organization Name:VIVEK C. VAID MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-559-3500
Mailing Address - Street 1:10509 ALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1662
Mailing Address - Country:US
Mailing Address - Phone:301-299-8924
Mailing Address - Fax:
Practice Address - Street 1:3311 TOLEDO TER STE B102
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-8146
Practice Address - Country:US
Practice Address - Phone:301-559-3500
Practice Address - Fax:301-853-2362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD116051600Medicaid
DCG00838OtherMEDICARE GROUP
DCC62619Medicare UPIN
DCG00838Medicare PIN