Provider Demographics
NPI:1356399927
Name:VAIDYA, ALZIRA F (MD)
Entity type:Individual
Prefix:MRS
First Name:ALZIRA
Middle Name:F
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:A
Other - Middle Name:F
Other - Last Name:VAIDYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:400 FAIRVIEW
Mailing Address - Street 2:ST 10
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601
Mailing Address - Country:US
Mailing Address - Phone:580-762-7701
Mailing Address - Fax:580-762-6914
Practice Address - Street 1:400 FAIRVIEW
Practice Address - Street 2:ST 10
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-762-7701
Practice Address - Fax:580-762-6914
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK160812084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100187470BMedicaid
OK100185330AMedicaid
C95599Medicare UPIN
OK100185330AMedicaid