Provider Demographics
NPI:1215094297
Name:GORADIA, AMI DINESH (MD)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:DINESH
Last Name:GORADIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 HAMILTON ST UNIT 609
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-4502
Mailing Address - Country:US
Mailing Address - Phone:267-252-3232
Mailing Address - Fax:
Practice Address - Street 1:1900 HAMILTON ST UNIT 609
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-4502
Practice Address - Country:US
Practice Address - Phone:267-252-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT182650207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology