Provider Demographics
NPI:1609972876
Name:RATHOD, VARSHA (MD)
Entity Type:Individual
Prefix:
First Name:VARSHA
Middle Name:
Last Name:RATHOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 SCHUETZ RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3551
Mailing Address - Country:US
Mailing Address - Phone:314-997-5403
Mailing Address - Fax:314-997-6837
Practice Address - Street 1:1977 SCHUETZ RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3551
Practice Address - Country:US
Practice Address - Phone:314-997-5403
Practice Address - Fax:314-997-6837
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5P42207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE80200Medicare UPIN