Provider Demographics
NPI:1760649867
Name:KENT, VAISHALI TRIVEDI (MD)
Entity Type:Individual
Prefix:DR
First Name:VAISHALI
Middle Name:TRIVEDI
Last Name:KENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 8TH AVE
Mailing Address - Street 2:SUITE 545
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4124
Mailing Address - Country:US
Mailing Address - Phone:817-912-8080
Mailing Address - Fax:817-912-8089
Practice Address - Street 1:1250 8TH AVE
Practice Address - Street 2:SUITE 545
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4124
Practice Address - Country:US
Practice Address - Phone:817-912-8080
Practice Address - Fax:817-912-8089
Is Sole Proprietor?:No
Enumeration Date:2008-05-18
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1158912086X0206X
TXP3178208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3080087-01Medicaid
TXTXB166571Medicare PIN