Provider Demographics
NPI:1811002173
Name:PIRACHA, ABDUL R (MD FACC)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:R
Last Name:PIRACHA
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19450 DEERFIELD AVE
Mailing Address - Street 2:STE 325
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8503
Mailing Address - Country:US
Mailing Address - Phone:304-487-1431
Mailing Address - Fax:304-425-5813
Practice Address - Street 1:100 NEW HOPE RD STE 7
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2143
Practice Address - Country:US
Practice Address - Phone:304-487-1431
Practice Address - Fax:304-425-5813
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09645174400000X
VA0101025342207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0087217000Medicaid
WVD49523Medicare UPIN
PI062133Medicare ID - Type Unspecified