MEDICARE: DR. ANUPAM R. VERMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	016869	ME
2	2080P0207X	Pediatric Hematology & Oncology Physician	6962530	UT

General Provider Information

NPI Number	:	1144258302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANUPAM R. VERMA MD

Provider Business Mailing Address
First Line	:	PO BOX 413021
Second Line	:	STE 4100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3021
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:	801-662-4707

Provider Business Practice Location Address
First Line	:	100 MARIO CAPECCHI DR
Second Line	:	STE 4100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84113-1103
Country	:	US
Telephone Number	:	801-662-4700
Fax Number	:	801-662-4707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	11/23/2021

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