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General NPI Number Information
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NPI Number | 1164530085
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Entity Type | Individual
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Provider Name | TRINETRA VAIDYA MD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 1400 N US HIGHWAY 441 STE 531
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City | LADY LAKE
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State | FL
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Zip | 32159-8985
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Country | US
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Telephone | 352-751-4885
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Fax | 352-751-5371
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Provider Business Mailing Address
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Address Line | 1901 SE 18TH AVE BUILDING # 400
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City | OCALA
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State | FL
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Zip | 34471-8215
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Country | US
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Telephone | 352-732-8905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME 94145
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License Number State | FL
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