Healthcare Provider Details

I. General information

NPI: 1720024730
Provider Name (Legal Business Name): VAIDY V NATHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 N MILLS AVE
ARCADIA FL
34266-8780
US

IV. Provider business mailing address

830 N MILLS AVE
ARCADIA FL
34266-8780
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-6599
  • Fax: 863-494-5467
Mailing address:
  • Phone: 863-494-6599
  • Fax: 863-494-5467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME61167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: