Provider Demographics
NPI:1255406773
Name:KANNAN, VAIDEHI (MD)
Entity type:Individual
Prefix:DR
First Name:VAIDEHI
Middle Name:
Last Name:KANNAN
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 1:9301 SNOWHILL ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1391
Mailing Address - Country:US
Mailing Address - Phone:301-617-0798
Mailing Address - Fax:
Practice Address - Street 1:9301 SNOWHILL ESTATES LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1391
Practice Address - Country:US
Practice Address - Phone:301-617-0798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047812291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory