Healthcare Provider Details

I. General information

NPI: 1871880989
Provider Name (Legal Business Name): VIRAL GORADIA M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2011
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 HARRISON ST
SYRACUSE NY
13210-2305
US

IV. Provider business mailing address

50 PRESIDENTIAL PLZ APT 704
SYRACUSE NY
13202-2229
US

V. Phone/Fax

Practice location:
  • Phone: 315-247-2447
  • Fax:
Mailing address:
  • Phone: 315-403-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number276813
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number276813
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: