Provider Demographics
NPI:1407070162
Name:VARANASI, ANJU B (MD)
Entity type:Individual
Prefix:DR
First Name:ANJU
Middle Name:B
Last Name:VARANASI
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 1:909 FROSTWOOD DR STE 1.405
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-5519
Mailing Address - Fax:
Practice Address - Street 1:17500 W GRAND PKWY S
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2562
Practice Address - Country:US
Practice Address - Phone:281-725-5026
Practice Address - Fax:281-725-5089
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066678A207Q00000X, 207R00000X
TXN5451208M00000X, 207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00760408OtherRAIL ROAD MEDICARE
IN200944160Medicaid
IN100180890GOtherMEDICAID GROUP
KY50027287OtherPASSPORT
000000618860OtherANTHEM PIN
KY7100090290Medicaid
940280K8Medicare PIN