Provider Demographics
NPI:1508046905
Name:VAIDYA, RASHMI PRADHAN (MD)
Entity Type:Individual
Prefix:
First Name:RASHMI
Middle Name:PRADHAN
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RASHMI
Other - Middle Name:PRAKASH
Other - Last Name:PRADHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:480-855-2224
Mailing Address - Fax:480-398-8080
Practice Address - Street 1:5810 W BEVERLY LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1800
Practice Address - Country:US
Practice Address - Phone:623-312-3000
Practice Address - Fax:623-312-3060
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51785208600000X
VA0101250512208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113899Medicaid