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Individual
VANESSA I VIDAL
Active
Individual
VANESSA I VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
229164
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2124939
—
MA
01
—
495592
TUFTS
MA
01
—
AA78063
HPHC
MA
01
—
J41183
BLUE CROSS
MA
Enumeration date
07/31/2006
Last updated
04/08/2010
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