MEDICARE: DR. RAZVAN THEODOR VAIDA M.D.

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	2084P0800X	Psychiatry Physician	MD417666	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H72324	OTHER	KY	UPIN

General Provider Information

NPI Number	:	1396739512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAZVAN THEODOR VAIDA M.D.

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:	N/A
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	781 FAR HILLS DR
Second Line	:	STE 600
City	:	NEW FREEDOM
State	:	PA
Zip	:	17349-9346
Country	:	US
Telephone Number	:	717-812-2560
Fax Number	:	717-812-2569

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	08/20/2024

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