Provider Demographics
NPI:1104000132
Name:NAVIN K VARMA MD PC
Entity Type:Organization
Organization Name:NAVIN K VARMA MD PC
Other - Org Name:CENTER FOR NEUROLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-479-7009
Mailing Address - Street 1:1452 E RIDGELINE DR STE 151
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405
Mailing Address - Country:US
Mailing Address - Phone:801-479-7009
Mailing Address - Fax:801-479-7020
Practice Address - Street 1:1452 E RIDGELINE DR STE 151
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-479-7009
Practice Address - Fax:801-479-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3459191205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT220967237011Medicaid
UT077861239003Medicaid
UT220967237011Medicaid
UT077861239003Medicaid