Provider Demographics
NPI:1780759050
Name:VAIDY, CHITRA (MD)
Entity type:Individual
Prefix:DR
First Name:CHITRA
Middle Name:
Last Name:VAIDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHITRA
Other - Middle Name:
Other - Last Name:VAIDYANATHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19899-0191
Mailing Address - Country:US
Mailing Address - Phone:904-697-4201
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:200 CLEAVER FARM RD STE 201
Practice Address - Street 2:NEMOURS DUPONT PEDIATRICS, MIDDLETOWN
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1630
Practice Address - Country:US
Practice Address - Phone:302-378-5100
Practice Address - Fax:302-378-5106
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004195208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0480363Medicaid
F99147Medicare UPIN