Provider Demographics
NPI:1235304288
Name:VARDHINI, BAKTHAVATSALAM PARVATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:BAKTHAVATSALAM
Middle Name:PARVATHA
Last Name:VARDHINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9740 HEALTHPARK CIRCLE
Mailing Address - Street 2:BASS RD, HOPE HOSPICE
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-985-7733
Mailing Address - Fax:239-482-8391
Practice Address - Street 1:9740 HEALTH PARK CIRCLE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-985-7733
Practice Address - Fax:239-482-8391
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211581207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine