Healthcare Provider Details

I. General information

NPI: 1144258302
Provider Name (Legal Business Name): ANUPAM R. VERMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR STE 4100
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

PO BOX 413021 STE 4100
SALT LAKE CITY UT
84141-3021
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-4700
  • Fax: 801-662-4707
Mailing address:
  • Phone: 801-213-3900
  • Fax: 801-662-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number016869
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number6962530
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: