Provider Demographics
NPI:1295754323
Name:VIRANI, AVANI K (MD)
Entity type:Individual
Prefix:
First Name:AVANI
Middle Name:K
Last Name:VIRANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AVANI
Other - Middle Name:M
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:506 BEECHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-5307
Mailing Address - Country:US
Mailing Address - Phone:302-250-0260
Mailing Address - Fax:
Practice Address - Street 1:1080 SILVER LAKE BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2410
Practice Address - Country:US
Practice Address - Phone:302-525-2149
Practice Address - Fax:302-734-5988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC70007091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000025914Medicaid
DE022736V95Medicare PIN
DE1000025914Medicaid