Provider Demographics
NPI:1922008440
Name:BETHI, VIDYA R (MD)
Entity Type:Individual
Prefix:DR
First Name:VIDYA
Middle Name:R
Last Name:BETHI
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 1:482 WARFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6071
Mailing Address - Country:US
Mailing Address - Phone:931-906-6644
Mailing Address - Fax:931-906-7805
Practice Address - Street 1:482 WARFIELD BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6071
Practice Address - Country:US
Practice Address - Phone:931-906-6644
Practice Address - Fax:931-906-7805
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027336207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3800894Medicaid
TN6151640001Medicare NSC
G28838Medicare UPIN
TN38008941Medicare PIN