Provider Demographics
NPI:1710180039
Name:DANDAVATE, VARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:VARSHA
Middle Name:
Last Name:DANDAVATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VARSHA
Other - Middle Name:MOHAN
Other - Last Name:DANDAVATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 RIVERVIEW AVE STE 710
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9040
Mailing Address - Fax:
Practice Address - Street 1:301 RIVERVIEW AVE STE 710
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10317100207RI0200X
VA0101276349207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ243399-01Medicaid
AZ243399-01Medicaid