Provider Demographics
NPI:1548227978
Name:BOINAPALLY, VAIDEHI (MD)
Entity Type:Individual
Prefix:DR
First Name:VAIDEHI
Middle Name:
Last Name:BOINAPALLY
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 751274
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1274
Mailing Address - Country:US
Mailing Address - Phone:919-620-4467
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:3024 PICKETT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6006
Practice Address - Country:US
Practice Address - Phone:919-490-9800
Practice Address - Fax:919-419-8564
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.15384R207R00000X
NC2013-00605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1195481Medicaid
103519Medicare UPIN
LA4F735Medicare ID - Type Unspecified