Provider Demographics
NPI:1184980609
Name:MANJUNATH, VARSHA (MD)
Entity type:Individual
Prefix:DR
First Name:VARSHA
Middle Name:
Last Name:MANJUNATH
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 1:270 LEIGH FARM RD
Mailing Address - Street 2:APT 408
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-8137
Mailing Address - Country:US
Mailing Address - Phone:603-566-8506
Mailing Address - Fax:
Practice Address - Street 1:270 LEIGH FARM RD
Practice Address - Street 2:APT 408
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-8137
Practice Address - Country:US
Practice Address - Phone:603-566-8506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-00067207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program