Provider Demographics
NPI:1891923256
Name:VAIDYA, KETA KIRAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:KETA
Middle Name:KIRAN
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 LOWELL DR SE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3754
Mailing Address - Country:US
Mailing Address - Phone:256-536-9031
Mailing Address - Fax:256-539-4240
Practice Address - Street 1:420 LOWELL DR SE
Practice Address - Street 2:SUITE 204
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3754
Practice Address - Country:US
Practice Address - Phone:256-536-9031
Practice Address - Fax:256-539-4240
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241589207R00000X
AL90364207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL174846Medicaid