Healthcare Provider Details

I. General information

NPI: 1619965944
Provider Name (Legal Business Name): NAVIN K VARMA MD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 E RIDGELINE DR #151
OGDEN UT
84405-4975
US

IV. Provider business mailing address

1452 E RIDGELINE DR # 151
OGDEN UT
84405-4975
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-7009
  • Fax: 801-479-7020
Mailing address:
  • Phone: 801-479-7009
  • Fax: 801-479-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number345919-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: