Healthcare Provider Details

I. General information

NPI: 1275532731
Provider Name (Legal Business Name): VARSHA LAXMAN PHERWANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MATTHEWS ST
MATTHEWS NC
28105-5027
US

IV. Provider business mailing address

PO BOX 602362
CHARLOTTE NC
28260-2362
US

V. Phone/Fax

Practice location:
  • Phone: 704-847-0572
  • Fax: 704-847-9760
Mailing address:
  • Phone: 704-847-0572
  • Fax: 704-847-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200801241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: