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General NPI Number Information
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NPI Number | 1548410095
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Entity Type | Individual
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Provider Name | SATYANARAYANA RAO VAIDYA MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 405 W JACKSON
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City | CARBONDALE
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State | IL
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Zip | 62901
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Country | US
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Telephone | 618-549-0721
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Fax | 618-529-0449
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Provider Business Mailing Address
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Address Line | 603 SKYLINE DRIVE APT #2
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City | MARION
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State | IL
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Zip | 62959
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Country | US
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Telephone | 616-206-1270
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301092793
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2015-01269
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 2015-01269
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036127222
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License Number State | IL
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