Provider Demographics
NPI:1851317341
Name:GAUDIANI, VINCENT A (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:GAUDIANI
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 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39320204F00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0052800Medicaid
CA00G393200Medicaid
CACP2153OtherRAILROAD MEDICARE
CAAP493Medicare PIN
CA00G393202Medicare PIN
CAA47783Medicare UPIN
CAZZZ23469ZMedicare PIN
CAZZZ05047ZMedicare PIN
CAGR0052800Medicaid
CAZZZ02406ZMedicare PIN
CABF306Medicare PIN
CACP2153OtherRAILROAD MEDICARE
CA00G393200Medicaid