Healthcare Provider Details

I. General information

NPI: 1952323040
Provider Name (Legal Business Name): VIDULA T VACHHARAJANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON-SALEM NC
27157
US

IV. Provider business mailing address

PO BOX 344
WINSTON SALEM NC
27102-0344
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax: 336-716-8190
Mailing address:
  • Phone: 336-716-2255
  • Fax: 336-716-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number2006-00910
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: