Individual
BHAVNA VAIDYA-TANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2076 NC HIGHWAY 42 W, STE. 230, CLAYTON, NC 27520-5302
(919) 553-5711
(919) 553-5712
Mailing address
5420 WADE PARK BLVD, STE 106, RALEIGH, NC 27607-4188
(919) 851-2174
(919) 854-7774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2004-00430
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138WA
BCBS
NC
05
—
891372V
—
NC
Enumeration date
05/24/2006
Last updated
03/05/2012
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