Healthcare Provider Details

I. General information

NPI: 1285833681
Provider Name (Legal Business Name): JAY KUMAR FISHLEDER VARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY KUMAR VARMA MD

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E ORANGE DR
PHOENIX AZ
85012-1429
US

IV. Provider business mailing address

10275 LITTLE PATUXENT PKWY STE 300
COLUMBIA MD
21044-3445
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-2370
  • Fax:
Mailing address:
  • Phone: 410-740-2370
  • Fax: 410-740-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number46623
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number46623
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: