Provider Demographics
NPI:1518117670
Name:VAIDYA, OMKAR ULHAS (MD)
Entity Type:Individual
Prefix:DR
First Name:OMKAR
Middle Name:ULHAS
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OMKAR
Other - Middle Name:ULHAS
Other - Last Name:VAIDYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8010 STATE LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3711
Mailing Address - Country:US
Mailing Address - Phone:913-400-3957
Mailing Address - Fax:913-400-3631
Practice Address - Street 1:65 HARRISON AVE STE 201
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1924
Practice Address - Country:US
Practice Address - Phone:617-513-8568
Practice Address - Fax:913-400-3631
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013031938207RC0200X, 207RN0300X
NMMD2021-0683207RN0300X
MA294382208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty