Provider Demographics
NPI:1528119591
Name:VAIDYA, ANAND (MD, MMSC)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:MD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BOYLSTON ST # 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2124
Mailing Address - Country:US
Mailing Address - Phone:617-290-3618
Mailing Address - Fax:
Practice Address - Street 1:221 LONGWOOD AVE # RFB
Practice Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL-ENDOCRINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5804
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233915207RE0101X
MA224851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine