Provider Demographics
NPI:1063701076
Name:FADIA, ANKUR S (MD)
Entity type:Individual
Prefix:
First Name:ANKUR
Middle Name:S
Last Name:FADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANKUR
Other - Middle Name:SUNILDATTA
Other - Last Name:FADIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13367
Mailing Address - Street 2:CARILION CLINIC CARDIOLOGY FELLOWSHIP PROGRAM
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24033-3367
Mailing Address - Country:US
Mailing Address - Phone:540-224-1008
Mailing Address - Fax:540-527-1039
Practice Address - Street 1:127 MCCLANAHAN ST SW
Practice Address - Street 2:CARILION CLINIC CARDIOLOGY FELLOWSHIP PROGRAM
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1728
Practice Address - Country:US
Practice Address - Phone:540-224-1008
Practice Address - Fax:540-527-1039
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254294207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine