Provider Demographics
NPI:1689690935
Name:PERICHERLA, VARMA S (MD)
Entity Type:Individual
Prefix:
First Name:VARMA
Middle Name:S
Last Name:PERICHERLA
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 1:2825 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-368-2606
Mailing Address - Fax:352-368-1620
Practice Address - Street 1:2825 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-368-2606
Practice Address - Fax:352-368-1620
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48264208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044728500Medicaid
FL044728500Medicaid
FL02491YMedicare PIN