Provider Demographics
NPI:1639186075
Name:VAIDYA, ABHAY MAKARAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHAY
Middle Name:MAKARAND
Last Name:VAIDYA
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 1:301 S MOORPARK RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1008
Mailing Address - Country:US
Mailing Address - Phone:805-379-9646
Mailing Address - Fax:805-379-0611
Practice Address - Street 1:301 S MOORPARK RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1008
Practice Address - Country:US
Practice Address - Phone:805-379-9646
Practice Address - Fax:805-379-0611
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86471207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00957559OtherMEDICARE RAILROAD
CAG86471OtherLICENSE
CAWG86471CMedicare PIN
CAG86471Medicare PIN
CAWG86471DMedicare PIN
CAP00957559OtherMEDICARE RAILROAD
CAG86471OtherLICENSE