Provider Demographics
NPI:1669405692
Name:VAIDYA, ABHAY (MD)
Entity type:Individual
Prefix:DR
First Name:ABHAY
Middle Name:
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ABHAYKUMAR
Other - Middle Name:DAMODAR
Other - Last Name:VAIDYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:399 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4815
Mailing Address - Country:US
Mailing Address - Phone:909-882-2266
Mailing Address - Fax:909-881-7593
Practice Address - Street 1:399 E 21ST ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4815
Practice Address - Country:US
Practice Address - Phone:909-882-2266
Practice Address - Fax:909-882-2266
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA363012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A363011Medicare PIN
CA00A363012Medicare PIN
CA00A363015Medicare PIN
CA00A363014Medicare PIN
CA00A363013Medicare PIN
CAA28031Medicare PIN