Provider Demographics
NPI:1053417543
Name:WRIGHT, KAADZE M (MD)
Entity type:Individual
Prefix:DR
First Name:KAADZE
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:68 SOUTH SERVICE ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101234569207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053417543Medicaid
VA298107OtherAMERIGROUP
VAK142-0001Other2005 CARE FIRST
VAP00132283OtherRAILROAD MEDICARE
VA137167OtherANTHEM
VA249159OtherKAISER
VA484645OtherNCPPO
VA249159OtherKAISER
VAK142-0001Other2005 CARE FIRST
VA298107OtherAMERIGROUP