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General NPI Number Information
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NPI Number | 1598839318
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Entity Type | Individual
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Provider Name | LAURA JANE GORADIA MD
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3990 STILLMAN PKWY
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City | GLEN ALLEN
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State | VA
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Zip | 23060-4167
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Country | US
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Telephone | 804-282-4210
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Fax | 804-282-4250
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Provider Business Mailing Address
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Address Line | 11830 ABERDEEN LANDING LN
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-2903
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Country | US
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Telephone | 804-272-3110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | VA0101840542
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License Number State | VA
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