Provider Demographics
NPI:1699775759
Name:VARMA, RAJA GUNTURI (MD)
Entity type:Individual
Prefix:DR
First Name:RAJA
Middle Name:GUNTURI
Last Name:VARMA
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 1:73 S OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3702
Mailing Address - Country:US
Mailing Address - Phone:631-627-8700
Mailing Address - Fax:631-627-8707
Practice Address - Street 1:73 S OCEAN AVE STE C
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3702
Practice Address - Country:US
Practice Address - Phone:631-627-8700
Practice Address - Fax:631-627-8707
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232713207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02587204Medicaid
NY044SX1Medicare ID - Type Unspecified
NY02587204Medicaid