Provider Demographics
NPI:1811052491
Name:NAVIWALA, TAHIRA (MD)
Entity type:Individual
Prefix:DR
First Name:TAHIRA
Middle Name:
Last Name:NAVIWALA
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 1:14051 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 2209
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3201
Mailing Address - Country:US
Mailing Address - Phone:804-288-2673
Mailing Address - Fax:804-639-8069
Practice Address - Street 1:14051 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 2209
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3201
Practice Address - Country:US
Practice Address - Phone:804-288-2673
Practice Address - Fax:804-639-8069
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239448207RG0300X, 207RH0002X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN
VA1811052491Medicaid
VA1811052491Medicaid