Provider Demographics
NPI:1295931145
Name:LATHIA, VIRAL (MD)
Entity type:Individual
Prefix:DR
First Name:VIRAL
Middle Name:
Last Name:LATHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 REGENCY PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7305
Mailing Address - Country:US
Mailing Address - Phone:551-208-1758
Mailing Address - Fax:682-499-1779
Practice Address - Street 1:309 REGENCY PKWY STE 205
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7305
Practice Address - Country:US
Practice Address - Phone:682-499-1777
Practice Address - Fax:682-499-1779
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24429207RC0000X
TXS0177207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3933251Medicaid
LA359694YJQDMedicare PIN