Provider Demographics
NPI:1336222025
Name:MITROO, VARUN (MD)
Entity Type:Individual
Prefix:
First Name:VARUN
Middle Name:
Last Name:MITROO
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 1:1867 E FIR AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3808
Mailing Address - Country:US
Mailing Address - Phone:559-325-5800
Mailing Address - Fax:
Practice Address - Street 1:1867 E FIR AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3808
Practice Address - Country:US
Practice Address - Phone:559-325-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4171512085R0202X
CAC528062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2634635OtherAETNA
PA132565OtherBLUE SHIELD PA
PA2018747000OtherKEYSTONE HEALTHPLAN EAST
PA0186159703OtherAMERICHOICE
PA0018615970001Medicaid
PA300131288Medicare ID - Type UnspecifiedRR MEDICARE
PA2634635OtherAETNA
PA054707Medicare PIN