Provider Demographics
NPI:1801810486
Name:BONAGIRI, VARA P (MD)
Entity type:Individual
Prefix:DR
First Name:VARA
Middle Name:P
Last Name:BONAGIRI
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:PO BOX R
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0289
Mailing Address - Country:US
Mailing Address - Phone:434-392-9000
Mailing Address - Fax:434-392-9215
Practice Address - Street 1:1400 MILNWOOD RD
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-0289
Practice Address - Country:US
Practice Address - Phone:434-392-9000
Practice Address - Fax:434-392-9215
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-03-01
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-30
Provider Licenses
StateLicense IDTaxonomies
VA0101054184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2121348OtherMAMSI
VA240277OtherSOUTHERN HEALTH
VA244915OtherANTHEM
VA110230281OtherRAILROAD MEDICARE
VA005865514Medicaid
VA005865514Medicaid
VA244915OtherANTHEM