Provider Demographics
NPI:1811984602
Name:KHARDORI, ROMESH K (MD)
Entity type:Individual
Prefix:
First Name:ROMESH
Middle Name:K
Last Name:KHARDORI
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5908
Mailing Address - Fax:757-446-7055
Practice Address - Street 1:855 W BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1005
Practice Address - Country:US
Practice Address - Phone:757-446-5908
Practice Address - Fax:757-446-7055
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249674207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1811984602OtherUNITED HEALTHCARE/MAMSI
VAPAROtherUSA MANAGED CARE
VAPAROtherCIGNA
VA-033OtherTRICARE/CHAMPUS
VA10080949OtherOPTIMA HEALTH
VAPAROtherAETNA
NC5918376Medicaid
VAPAROtherCORVEL
VA1811984602OtherFIRST HEALTH NETWORK/SOUTHERN HEALTH/COVENTRY NATIONAL
VA1811984602Medicaid
VAPAROtherMULTIPLAN
VA1811984602OtherVIRGINIA PREMIER HEALTH PLAN
VA442639OtherANTHEM BC/BS
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCIGNA
VAPAROtherAETNA
NC5918376Medicaid