Healthcare Provider Details

I. General information

NPI: 1114991536
Provider Name (Legal Business Name): CHANDRA VARIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11021 MAIN ST
MARTIN KY
41649-7999
US

IV. Provider business mailing address

11021 MAIN ST
MARTIN KY
41649-7999
US

V. Phone/Fax

Practice location:
  • Phone: 606-285-9221
  • Fax: 606-285-6428
Mailing address:
  • Phone: 606-285-9221
  • Fax: 606-285-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20525
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: