Provider Demographics
NPI:1942452925
Name:VAIDA M. STOIK MD PC
Entity Type:Organization
Organization Name:VAIDA M. STOIK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAIDA
Authorized Official - Middle Name:MACIUTE
Authorized Official - Last Name:STOIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-477-4872
Mailing Address - Street 1:1650 HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4769
Mailing Address - Country:US
Mailing Address - Phone:505-216-3745
Mailing Address - Fax:505-982-5003
Practice Address - Street 1:1650 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4769
Practice Address - Country:US
Practice Address - Phone:505-216-3745
Practice Address - Fax:505-982-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2008-0204207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2492888Medicaid
4145711Medicare PIN
I20147Medicare UPIN