Provider Demographics
NPI:1891795316
Name:VARMA, SURENDRAN RAJA RAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:SURENDRAN
Middle Name:RAJA RAJA
Last Name:VARMA
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 1:625 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4068
Mailing Address - Country:US
Mailing Address - Phone:860-583-7700
Mailing Address - Fax:860-589-7656
Practice Address - Street 1:625 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4068
Practice Address - Country:US
Practice Address - Phone:860-583-7700
Practice Address - Fax:860-589-7656
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232460207R00000X
CT043632207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02592556Medicaid
CT1891795316Medicaid
CTD400002073Medicare PIN
CT1891795316Medicaid
NYI17378Medicare UPIN