Healthcare Provider Details

I. General information

NPI: 1184976086
Provider Name (Legal Business Name): VARMA PENUMETCHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CENTER ST NE
SALEM OR
97301-2682
US

IV. Provider business mailing address

2600 CENTER ST NE
SALEM OR
97301-2682
US

V. Phone/Fax

Practice location:
  • Phone: 503-269-0783
  • Fax:
Mailing address:
  • Phone: 503-269-0783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD181231
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: