Organization
S V VAIDYA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. S V VAIDYA MD (OWNER)
(580) 762-7734
Entity
Organization
Contact information
Practice address
400 FAIRVIEW AVE, SUITE 10, PONCA CITY, OK 74601-1920
(580) 762-7734
(580) 762-6914
Mailing address
400 FAIRVIEW AVE, SUITE 10, PONCA CITY, OK 74601-1920
(580) 762-7734
(580) 762-6914
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
16078
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010998
PTAN
KS
05
—
100185320A
—
OK
05
—
100206890B
—
KS
Enumeration date
04/16/2008
Last updated
06/10/2008
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