Provider Demographics
NPI:1598839318
Name:GORADIA, LAURA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JANE
Last Name:GORADIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11830 ABERDEEN LANDING LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2903
Mailing Address - Country:US
Mailing Address - Phone:804-272-3110
Mailing Address - Fax:
Practice Address - Street 1:3990 STILLMAN PKWY
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4167
Practice Address - Country:US
Practice Address - Phone:804-282-4210
Practice Address - Fax:804-282-4250
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0101840542208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG49050Medicare UPIN