Provider Demographics
NPI:1427015577
Name:VARANDANI, JAI K (MD)
Entity type:Individual
Prefix:MR
First Name:JAI
Middle Name:K
Last Name:VARANDANI
Suffix:
Gender:M
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:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-0187
Mailing Address - Country:US
Mailing Address - Phone:276-546-1182
Mailing Address - Fax:276-546-2497
Practice Address - Street 1:1119 LAKE ST
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2007
Practice Address - Country:US
Practice Address - Phone:276-546-1182
Practice Address - Fax:276-546-2497
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006087670Medicaid
VAC01115Medicare Oscar/Certification
012949676Medicare PIN
VA006087670Medicaid