Provider Demographics
NPI:1174919872
Name:BHAMIDIPATI, VINAY (MD)
Entity type:Individual
Prefix:
First Name:VINAY
Middle Name:
Last Name:BHAMIDIPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SE 8TH AVE APT 720
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3885
Mailing Address - Country:US
Mailing Address - Phone:609-457-1076
Mailing Address - Fax:
Practice Address - Street 1:4900 W OAKLAND PARK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1555
Practice Address - Country:US
Practice Address - Phone:954-945-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277330207Q00000X
FLME139011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME139011OtherFLORIDA MEDICAL LICENSE
MA277330OtherMASSACHUSETTS MEDICAL LICENSE