Basic Information
Provider Information | |||||||||
NPI: | 1306810049 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GAVRIS | ||||||||
FirstName: | MIHAI | ||||||||
MiddleName: | F. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5801 BREMO ROAD | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232261907 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8042850620 | ||||||||
FaxNumber: | 8042850726 | ||||||||
Practice Location | |||||||||
Address1: | 5801 BREMO ROAD | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232261907 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8042850620 | ||||||||
FaxNumber: | 8042850726 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/16/2006 | ||||||||
LastUpdateDate: | 07/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/08/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 12876 | NH | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 0101249874 | VA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | 0101249874 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 1091787 | 01 | NH | AETNA PIN | OTHER | 494439 | 01 | NH | TUFTS PIN | OTHER | H70079 | 01 | NH | ANTHEM REFERRING UPIN | OTHER | 01YP08682NH01 | 01 | NH | ANTHEM BCBS PIN | OTHER | H70079 | 01 | NH | HARVARD PILGRIM PIN | OTHER | 30205438 | 05 | NH |   | MEDICAID | 5938755 | 01 | NH | CIGNA PIN | OTHER |