MEDICARE: KEDARNATH A VAIDYA 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	207RI0011X	Interventional Cardiology Physician	M3100	TX
2	207U00000X	Nuclear Medicine Physician	M3100	TX
3	207RC0000X	Cardiovascular Disease Physician	M3100	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00J21A	OTHER	TX	GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568466365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEDARNATH A VAIDYA MD

Provider Business Mailing Address
First Line	:	17350 ST LUKES WAY STE 400
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77384-4167
Country	:	US
Telephone Number	:	281-444-3278
Fax Number	:

Provider Business Practice Location Address
First Line	:	17350 ST LUKES WAY
Second Line	:	SUITE 400
City	:	THE WOODLANDS
State	:	TX
Zip	:	77384-4167
Country	:	US
Telephone Number	:	281-444-3278
Fax Number	:	832-249-3861

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/21/2025

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1861493389 — BRENDA KAY PEABODY M.D.
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1033110101 — JULIA ANN MANNING CNP
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1821158015 — MS. BARBARA JEAN KIMMONS PAC
Practice Location Address:

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Directions to “ KEDARNATH A VAIDYA MD” Practice Location

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