Provider Demographics
NPI:1437204740
Name:KADIRI, MOHAMED IDRISSI (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:IDRISSI
Last Name:KADIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMED
Other - Middle Name:
Other - Last Name:QADIRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 ROANOKE ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3025
Mailing Address - Country:US
Mailing Address - Phone:540-381-6000
Mailing Address - Fax:540-381-2989
Practice Address - Street 1:205 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3025
Practice Address - Country:US
Practice Address - Phone:540-381-6000
Practice Address - Fax:540-381-2989
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241526207Q00000X
TXBP10017538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014570C29Medicare PIN
VAP00426471Medicare PIN
VA018037C18Medicare PIN
VA016767C40Medicare PIN