Provider Demographics
NPI:1053304311
Name:GHADIRI, GUITA (MD)
Entity Type:Individual
Prefix:DR
First Name:GUITA
Middle Name:
Last Name:GHADIRI
Suffix:
Gender:F
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:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-0693
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 HUGUENOT RD
Practice Address - Street 2:SUITE 309
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4311
Practice Address - Country:US
Practice Address - Phone:804-955-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426805207R00000X, 207RN0300X
VA0101256855207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA947471OtherCAREFIRST MD BCBS
PA20082336OtherAMERIHEALTH MERCY-WMG
PA1744727OtherHIGHMARK BLUE SHIELD
PA226982OtherJOHNS HOPKINS
PA3625OtherGEISINGER HEALTH PLAN
PA1013229970001Medicaid
PA101322997Medicaid
PA50082793OtherCAPITAL BLUE CROSS-WMG
PA1545720OtherGATEWAY-WMG
PA259802OtherUNISON-WMG
PA1013229970001Medicaid
PA1744727OtherHIGHMARK BLUE SHIELD
PA50082793OtherCAPITAL BLUE CROSS-WMG
PA947471OtherCAREFIRST MD BCBS