Provider Demographics
NPI:1508073891
Name:ANGADI, VIVEK C (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:C
Last Name:ANGADI
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 26901
Mailing Address - Street 2:WP1140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126
Mailing Address - Country:US
Mailing Address - Phone:405-271-4351
Mailing Address - Fax:405-271-8695
Practice Address - Street 1:24 S 18TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5622
Practice Address - Country:US
Practice Address - Phone:610-628-8375
Practice Address - Fax:610-628-8648
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439111207L00000X, 207LP3000X
OK35471207L00000X, 207LP3000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program