Healthcare Provider Details

I. General information

NPI: 1316082555
Provider Name (Legal Business Name): SHRIKANT K VAIDYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 VALLEY DR SUITE 016
POINT PLEASANT WV
25550-2031
US

IV. Provider business mailing address

PO BOX 449
MARIETTA OH
45750
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-6060
  • Fax: 304-675-5001
Mailing address:
  • Phone: 740-374-4500
  • Fax: 740-374-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13842
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.053340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: