Individual provider Active NPI

Erlinda P Vidal, M.D.

  • Anesthesiology Physician
  • Watertown, NY
National Provider Identifier
1346286234
Registry record updated Apr 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
119755 Issued in NY
Practice address
830 Washington St
Watertown, NY 13601-4066
Phone
(315) 785-8509
Fax
(315) 785-8619
NPI assigned
Jun 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 119755 NY Primary

Addresses

Primary practice location

830 Washington St
Watertown, NY 13601-4066

Mailing address

445 Factory St
PO Box 91
Watertown, NY 13601-2729
Phone (315) 782-4207

Other identifiers 1

IdentifierTypeStateIssuer
00485438MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
119755NYMDAnesthesiology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209513600000",
    "number": "1346286234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 FACTORY ST",
            "address_2": "PO BOX 91",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012729",
            "telephone_number": "315-782-4207",
            "fax_number": "315-782-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014066",
            "telephone_number": "315-785-8509",
            "fax_number": "315-785-8619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "ERLINDA",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2008-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "119755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00485438",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.