Provider Demographics
NPI:1740274836
Name:GORADIA, VIPOOL KIRIT (MD)
Entity type:Individual
Prefix:MR
First Name:VIPOOL
Middle Name:KIRIT
Last Name:GORADIA
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 1:14241 MIDLOTHIAN TPKE # 211
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6500
Mailing Address - Country:US
Mailing Address - Phone:804-938-9727
Mailing Address - Fax:
Practice Address - Street 1:100 CONCOURSE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5642
Practice Address - Country:US
Practice Address - Phone:804-678-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
VA010105923207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG22263Medicare UPIN
172390OtherANTHEM
VAG22263Medicare UPIN
VA00W350G01Medicare PIN