Provider Demographics
NPI:1760610091
Name:JAGHORI, FRESHTA (MD)
Entity Type:Individual
Prefix:
First Name:FRESHTA
Middle Name:
Last Name:JAGHORI
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 1:1231 N TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3116
Mailing Address - Country:US
Mailing Address - Phone:941-366-0134
Mailing Address - Fax:
Practice Address - Street 1:1001 MONTICELLO AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2564
Practice Address - Country:US
Practice Address - Phone:757-346-5770
Practice Address - Fax:866-292-0928
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22847207RI0200X
LA300031207RI0200X
VA0101251757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA300031OtherLA LICENSE
VA10092499OtherOPTIMA HEALTH
VA1760610091OtherCOVENTRY HEALTH NETWORK
VAPAROtherVIRGINIA HEALTH NETWORK
VA1760610091Medicaid
VAPAROtherAETNA
VA1760610091OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherCORVEL
VAPAROtherUSA MANAGED CARE
VAPAROtherCIGNA
VAPAROtherMULTIPLAN
NC5920235Medicaid
VA1760610091OtherUNITED HEALTHCARE
VA-028OtherTRICARE/CHAMPUS
VA470311OtherANTHEM BC/BS
VA1760610091OtherUNITED HEALTHCARE