MEDICARE: DR. GAURANG NANDKISHOR VAIDYA

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	207RC0000X	Cardiovascular Disease Physician	49637	KY
2	207RC0000X	Cardiovascular Disease Physician	103698	GA
3	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	A162316	CA
4	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	103698	GA
5	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	49637	KY

General Provider Information

NPI Number	:	1558701748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAURANG NANDKISHOR VAIDYA

Provider Business Mailing Address
First Line	:	3306 SHASTA DR
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-3709
Country	:	US
Telephone Number	:	310-923-2034
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-5173
Country	:	US
Telephone Number	:	310-923-2034
Fax Number	:

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

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	11/20/2025

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