Provider Demographics
NPI:1770583502
Name:VERMA, INDRAJIT (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:INDRAJIT
Middle Name:
Last Name:VERMA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5349 DARBY WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1734
Mailing Address - Country:US
Mailing Address - Phone:904-553-4245
Mailing Address - Fax:904-549-9586
Practice Address - Street 1:1302 RIVER ST
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-5042
Practice Address - Country:US
Practice Address - Phone:386-326-7342
Practice Address - Fax:386-325-1086
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP82700Medicare UPIN