Provider Demographics
NPI:1710978523
Name:VAID, KULDIP KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KULDIP
Middle Name:KUMAR
Last Name:VAID
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 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:454 BROADWAY STE 106
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3050
Practice Address - Country:US
Practice Address - Phone:781-286-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-01
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75927207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA729023OtherTUFTS HEALTH PLAN
MA3097129Medicaid
MAJ12331OtherBCBS MA
MA3097129Medicaid
MAJ12331Medicare ID - Type Unspecified