MEDICARE: MOHAN T VAIDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101031585	VA

General Provider Information

NPI Number	:	1134107642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAN T VAIDY MD

Provider Business Mailing Address
First Line	:	CENTRAL STATE HOSPITAL
Second Line	:	P.O.BOX 4030
City	:	PETERSBURG
State	:	VA
Zip	:	23803
Country	:	US
Telephone Number	:	804-524-7000
Fax Number	:	804-524-4717

Provider Business Practice Location Address
First Line	:	4924 COCHISE TRL
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23237-2568
Country	:	US
Telephone Number	:	804-524-7000
Fax Number	:	804-524-4717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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