Provider Demographics
NPI:1851489231
Name:VARMA, RAGHUNANDAN MEDAVARAM (DO)
Entity Type:Individual
Prefix:DR
First Name:RAGHUNANDAN
Middle Name:MEDAVARAM
Last Name:VARMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOLLY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3525
Mailing Address - Country:US
Mailing Address - Phone:973-715-8025
Mailing Address - Fax:973-895-5050
Practice Address - Street 1:7 DOLLY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-3525
Practice Address - Country:US
Practice Address - Phone:973-715-8025
Practice Address - Fax:973-895-5050
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB070051207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8185000Medicaid
NJ037024Medicare PIN
930118054Medicare PIN
H13545Medicare UPIN