Provider Demographics
NPI:1063542793
Name:DHARMAVARAPU, SUNITA (MD)
Entity type:Individual
Prefix:DR
First Name:SUNITA
Middle Name:
Last Name:DHARMAVARAPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8054
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-286-1050
Mailing Address - Fax:314-344-1138
Practice Address - Street 1:2 PROGRESS POINT CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2208
Practice Address - Country:US
Practice Address - Phone:314-286-1050
Practice Address - Fax:314-344-1138
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003004999207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL321903447Medicaid
IL321903447Medicaid