Provider Demographics
NPI:1245457886
Name:VARANASI, JYOTHI P (MD)
Entity type:Individual
Prefix:MS
First Name:JYOTHI
Middle Name:P
Last Name:VARANASI
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:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-376-5315
Mailing Address - Fax:
Practice Address - Street 1:2138 25TH ST STE F
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3241
Practice Address - Country:US
Practice Address - Phone:812-376-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071255A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201109690Medicaid
INP01280680OtherRAILROAD MEDICARE
IN000000990877OtherANTHEM PIN
ININ1105005Medicare PIN
INP01280680OtherRAILROAD MEDICARE
ININ2762082Medicare PIN