Provider Demographics
NPI:1952184368
Name:DIABETES VIRTUAL CLINIC LLC
Entity Type:Organization
Organization Name:DIABETES VIRTUAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARANASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-269-5618
Mailing Address - Street 1:4903 W BAY WAY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-4803
Mailing Address - Country:US
Mailing Address - Phone:727-345-5222
Mailing Address - Fax:727-345-4066
Practice Address - Street 1:4903 W BAY WAY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-4803
Practice Address - Country:US
Practice Address - Phone:727-345-5222
Practice Address - Fax:727-345-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty