Healthcare Provider Details

I. General information

NPI: 1780942383
Provider Name (Legal Business Name): GAUTAM VERMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WESCOTT DR STE G3
FLEMINGTON NJ
08822-4600
US

IV. Provider business mailing address

1100 WESCOTT DR STE G3
FLEMINGTON NJ
08822-4600
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-1710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA11758100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number281660
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number281660
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: