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Individual

MRS. ASHWINI KAMATH VAIDYA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2121 E 21ST ST, TULSA, OK 74114-1409
(918) 749-2261
(918) 749-8712
Mailing address
PO BOX 52588, TULSA, OK 74152-0588
(918) 749-2261
(918) 749-8712

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
23219
OK
207NS0135X
Procedural Dermatology Physician
23219
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100749090B
OK
01
P00063251
RAILROAD MEDICARE
OK
Enumeration date
11/21/2005
Last updated
10/11/2012
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