Basic Information
Provider Information | |||||||||
NPI: | 1821097031 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SARAIYA | ||||||||
FirstName: | SHARAD KUMAR | ||||||||
MiddleName: | N. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 13000 RIVERS BEND BLVD | ||||||||
Address2: | STE D | ||||||||
City: | CHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 238368632 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8045715106 | ||||||||
FaxNumber: | 8045301857 | ||||||||
Practice Location | |||||||||
Address1: | 325 CHARLES H DIMMOCK PKWY STE 100 | ||||||||
Address2: |   | ||||||||
City: | COLONIAL HEIGHTS | ||||||||
State: | VA | ||||||||
PostalCode: | 238342986 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8045265888 | ||||||||
FaxNumber: | 8045265401 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/19/2005 | ||||||||
LastUpdateDate: | 12/05/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0101036726 | VA | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 006425232 | 05 | VA |   | MEDICAID | 200010483 | 01 | VA | RAILROAD MEDICARE | OTHER |