Healthcare Provider Details

I. General information

NPI: 1629020318
Provider Name (Legal Business Name): HARIDAS K VARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HARRISON ST STE 250
JOHNSON CITY NY
13790
US

IV. Provider business mailing address

30 HARRISON ST STE 250
JOHNSON CITY NY
13790
US

V. Phone/Fax

Practice location:
  • Phone: 607-770-8600
  • Fax: 607-770-0853
Mailing address:
  • Phone: 607-770-8600
  • Fax: 607-770-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number106672
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: