1144250820 NPI number — RUPASHREE VARADARAJAN M.D.

Table of content: RUPASHREE VARADARAJAN M.D. (NPI 1144250820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144250820 NPI number — RUPASHREE VARADARAJAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARADARAJAN
Provider First Name:
RUPASHREE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144250820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14883
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27415-4883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-274-6515
Provider Business Mailing Address Fax Number:
336-691-8042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 E WENDOVER AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-274-3241
Provider Business Practice Location Address Fax Number:
336-272-7134
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2004-01344 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 203243087 . This is a "WELLPATH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203243087 . This is a "GREATWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7371814 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 185153 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7442775 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14008 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2563633 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203242087 . This is a "PHCS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5902336 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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