Provider Demographics
NPI:1154329530
Name:VARMA, PRABHAT K (MD)
Entity Type:Individual
Prefix:
First Name:PRABHAT
Middle Name:K
Last Name:VARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2211 GENESEE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-733-7598
Mailing Address - Fax:315-733-2102
Practice Address - Street 1:2211 GENESEE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5930
Practice Address - Country:US
Practice Address - Phone:315-733-7598
Practice Address - Fax:315-733-2102
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2012-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY185148207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01474148Medicaid
NY01474148Medicaid
NY39498CMedicare ID - Type Unspecified