Provider Demographics
NPI:1659373553
Name:VAIDYANATHAN, CHANDRASEKAR (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRASEKAR
Middle Name:
Last Name:VAIDYANATHAN
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 1:2055 HOSPITAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1978
Mailing Address - Country:US
Mailing Address - Phone:513-732-0663
Mailing Address - Fax:513-732-1232
Practice Address - Street 1:2055 HOSPITAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1978
Practice Address - Country:US
Practice Address - Phone:513-732-0663
Practice Address - Fax:513-732-1232
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-0962V207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311715108032OtherCARESOURCE
OH000000216575OtherANTHEM
110235460OtherRAILROAD MEDICARE
0403552OtherUNITED HEALTHCARE
5864282OtherAETNA
OH70962OtherHUMANA
OH0422493Medicaid
478030OtherPHCS
110235460OtherRAILROAD MEDICARE
OH000000216575OtherANTHEM
478030OtherPHCS
OH4218321Medicare PIN