Provider Demographics
NPI:1649263450
Name:VAIDYA, ATUL M (MD)
Entity type:Individual
Prefix:
First Name:ATUL
Middle Name:M
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5020 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3307
Mailing Address - Country:US
Mailing Address - Phone:918-492-3636
Mailing Address - Fax:918-494-8915
Practice Address - Street 1:5020 E 68TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3307
Practice Address - Country:US
Practice Address - Phone:918-492-3636
Practice Address - Fax:918-494-8915
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23223207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94661Medicare UPIN