Healthcare Provider Details

I. General information

NPI: 1649684069
Provider Name (Legal Business Name): RHEA VIDRINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST 4TH FLOOR
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

1284 APEX LN
CHARLESTON SC
29412-8639
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-0921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL37099
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53966
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number53966
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: