Provider Demographics
NPI:1649556705
Name:VARADACHARI, RANGASAMI (MD)
Entity Type:Individual
Prefix:
First Name:RANGASAMI
Middle Name:
Last Name:VARADACHARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16338 CHAMPION DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-5403
Mailing Address - Country:US
Mailing Address - Phone:636-530-0361
Mailing Address - Fax:636-536-9815
Practice Address - Street 1:16338 CHAMPION DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-5403
Practice Address - Country:US
Practice Address - Phone:636-530-0361
Practice Address - Fax:636-536-9815
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000156778207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery