Provider Demographics
NPI:1750764379
Name:JAIN, VARUN (MD)
Entity type:Individual
Prefix:DR
First Name:VARUN
Middle Name:
Last Name:JAIN
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 1:114 WOODLAND ST
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1299
Mailing Address - Country:US
Mailing Address - Phone:860-714-7446
Mailing Address - Fax:860-714-1508
Practice Address - Street 1:114 WOODLAND STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1299
Practice Address - Country:US
Practice Address - Phone:860-714-7446
Practice Address - Fax:860-714-1508
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMTL002867390200000X
CT57043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program