Provider Demographics
NPI:1023281136
Name:VIDI, SMITHA RAO (MD)
Entity type:Individual
Prefix:
First Name:SMITHA
Middle Name:RAO
Last Name:VIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SMITHA
Other - Middle Name:RAO
Other - Last Name:CHILLAMBHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-456-2857
Mailing Address - Fax:214-456-5406
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-456-2857
Practice Address - Fax:214-456-5406
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ59472080P0210X
MAL-234741208000000X
PAMD444085208000000X
PAMT1989302080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics