Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | L-234741 | MA |
N | 208000000X | Pediatrician | MD444085 | PA |
N | 2080P0210X | Pediatric Nephrologist | MT198930 | PA |
Y | 2080P0210X | Pediatric Nephrologist | Q5947 | TX |
NPI | 1023281136 |
---|---|
Provider Name | Smitha Rao Vidi |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 03/11/2015 |