Healthcare Provider Details

I. General information

NPI: 1811984602
Provider Name (Legal Business Name): ROMESH K. KHARDORI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 W BRAMBLETON AVE
NORFOLK VA
23510-1005
US

IV. Provider business mailing address

PO BOX 936
NORFOLK VA
23501-0936
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-5908
  • Fax: 757-446-7055
Mailing address:
  • Phone: 757-446-5908
  • Fax: 757-446-7055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101249674
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: