Provider Demographics
NPI:1871880989
Name:GORADIA, VIRAL (MBBS)
Entity type:Individual
Prefix:DR
First Name:VIRAL
Middle Name:
Last Name:GORADIA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PRESIDENTIAL PLZ
Mailing Address - Street 2:APT 704
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2229
Mailing Address - Country:US
Mailing Address - Phone:315-403-4271
Mailing Address - Fax:
Practice Address - Street 1:713 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2305
Practice Address - Country:US
Practice Address - Phone:315-247-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2768132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program