Healthcare Provider Details

I. General information

NPI: 1649965930
Provider Name (Legal Business Name): VARUN VANKESHWARAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 TARBORO ST SW
WILSON NC
27893-3428
US

IV. Provider business mailing address

99 HIGHWAY 37 W
TOMS RIVER NJ
08755-6423
US

V. Phone/Fax

Practice location:
  • Phone: 252-399-7410
  • Fax:
Mailing address:
  • Phone: 732-557-2110
  • 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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-02977
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: