Provider Demographics
NPI:1003032541
Name:GORADIA ORTHOPEDICS, PLLC
Entity Type:Organization
Organization Name:GORADIA ORTHOPEDICS, PLLC
Other - Org Name:GO ORTHOPEDICS AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIPOOL
Authorized Official - Middle Name:KIRIT
Authorized Official - Last Name:GORADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-452-1635
Mailing Address - Street 1:281 EAST HUNDRED RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836
Mailing Address - Country:US
Mailing Address - Phone:804-452-1635
Mailing Address - Fax:804-452-1638
Practice Address - Street 1:281 EAST HUNDRED RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836
Practice Address - Country:US
Practice Address - Phone:804-452-1635
Practice Address - Fax:804-452-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059293261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA295163OtherANTHEM PROVIDER NUM. PT
VA6402411Medicare UPIN
VAC09483Medicare PIN