Provider Demographics
NPI:1003821653
Name:GORADIA ORTHOPAEDICS, PLLC
Entity Type:Organization
Organization Name:GORADIA ORTHOPAEDICS, PLLC
Other - Org Name:G2 ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIPOOL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GORADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-678-9000
Mailing Address - Street 1:100 CONCOURSE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5642
Mailing Address - Country:US
Mailing Address - Phone:804-678-9000
Mailing Address - Fax:
Practice Address - Street 1:100 CONCOURSE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5642
Practice Address - Country:US
Practice Address - Phone:804-678-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5533820001Medicare NSC
VAC09483Medicare PIN
VA172388OtherANTHEM PAY TO #