MEDICARE: VIDYA MAVE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		DE

General Provider Information

NPI Number	:	1043265630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIDYA MAVE M.D.

Provider Business Mailing Address
First Line	:	850 S. COAST HIGHWAY
Second Line	:	BETHANY PRIMARY CARE
City	:	BETHANY BEACH
State	:	DE
Zip	:	19930-0000
Country	:	US
Telephone Number	:	302-537-1100
Fax Number	:	302-537-0921

Provider Business Practice Location Address
First Line	:	850 S. COAST HIGHWAY
Second Line	:
City	:	BETHANY BEACH
State	:	DE
Zip	:	19930-0000
Country	:	US
Telephone Number	:	302-537-1100
Fax Number	:	302-537-0921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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