Provider Demographics
NPI:1538117015
Name:VIRADIA, CHANDRESH VITHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRESH
Middle Name:VITHAL
Last Name:VIRADIA
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 1:100 JIM MASON CT
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8965
Mailing Address - Country:US
Mailing Address - Phone:478-971-4001
Mailing Address - Fax:478-971-4004
Practice Address - Street 1:100 JIM MASON CT
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8965
Practice Address - Country:US
Practice Address - Phone:478-971-4001
Practice Address - Fax:478-971-4004
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053050208VP0014X, 207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH93989Medicare UPIN