Provider Demographics
NPI:1710205000
Name:VARMA, DIVYASHREE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIVYASHREE
Middle Name:
Last Name:VARMA
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 1:4444 N 32ND ST STE 175
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3999
Mailing Address - Country:US
Mailing Address - Phone:602-952-0002
Mailing Address - Fax:602-224-9119
Practice Address - Street 1:4444 N 32ND ST STE 175
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3999
Practice Address - Country:US
Practice Address - Phone:602-952-0002
Practice Address - Fax:602-224-9119
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58467207RC0000X, 207RC0001X
MI4301111507207RC0000X
TXQ9260207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361116201Medicaid
TX361116202OtherCSHCN
TX361116202OtherCSHCN