Healthcare Provider Details

I. General information

NPI: 1841496940
Provider Name (Legal Business Name): DR KULDIP VAID MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 BROADWAY SUITE 106
REVERE MA
02151-3034
US

IV. Provider business mailing address

454 BROADWAY SUITE 106
REVERE MA
02151-3034
US

V. Phone/Fax

Practice location:
  • Phone: 781-286-5854
  • Fax: 781-286-3971
Mailing address:
  • Phone: 781-286-5854
  • Fax: 781-286-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number75927
License Number StateMA

VIII. Authorized Official

Name: MRS. VITA R. SALVAGGIO
Title or Position: OFFICE MANAGER
Credential:
Phone: 781-286-5854