Healthcare Provider Details

I. General information

NPI: 1184980609
Provider Name (Legal Business Name): VARSHA MANJUNATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 LEIGH FARM RD APT 408
DURHAM NC
27707-8137
US

IV. Provider business mailing address

270 LEIGH FARM RD APT 408
DURHAM NC
27707-8137
US

V. Phone/Fax

Practice location:
  • Phone: 603-566-8506
  • Fax:
Mailing address:
  • Phone: 603-566-8506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD60617818
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2015-00067
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: