Provider Demographics
NPI:1689782484
Name:GORADIA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GORADIA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TUSHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GORADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:916-534-1234
Mailing Address - Street 1:548 MARKET ST # 48710
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5401
Mailing Address - Country:US
Mailing Address - Phone:916-534-1234
Mailing Address - Fax:916-534-1235
Practice Address - Street 1:6501 COYLE AVENUE
Practice Address - Street 2:ATTENTION: MEDICAL STAFF OFFICE, TUSHAR GORADIA MD
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-537-5000
Practice Address - Fax:916-534-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30211ZMedicare ID - Type Unspecified