Provider Demographics
NPI:1003154337
Name:KADDAHA, FIRAS (MD)
Entity Type:Individual
Prefix:
First Name:FIRAS
Middle Name:
Last Name:KADDAHA
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 1:900 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1131
Mailing Address - Country:US
Mailing Address - Phone:434-392-4370
Mailing Address - Fax:434-200-2854
Practice Address - Street 1:900 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1131
Practice Address - Country:US
Practice Address - Phone:434-392-4370
Practice Address - Fax:434-200-2854
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260539207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease