Healthcare Provider Details

I. General information

NPI: 1811206816
Provider Name (Legal Business Name): DINESH KADARIYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2010
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH STREET ACC BUILDING
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

655 W 8TH STREET ACC BUILDING
JACKSONVILLE FL
32209
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-2655
  • Fax: 904-244-5913
Mailing address:
  • Phone: 904-244-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101257254
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME155320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: