Provider Demographics
NPI:1144250820
Name:VARADARAJAN, RUPASHREE (MD)
Entity type:Individual
Prefix:
First Name:RUPASHREE
Middle Name:
Last Name:VARADARAJAN
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:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-274-6515
Mailing Address - Fax:336-691-8042
Practice Address - Street 1:301 E WENDOVER AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1232
Practice Address - Country:US
Practice Address - Phone:336-274-3241
Practice Address - Fax:336-272-7134
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-01344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
203243087OtherWELLPATH
203243087OtherGREATWEST
NC7371814OtherCIGNA HEALTHCARE
NC185153OtherMEDCOST
7442775OtherAETNA
NC14008OtherBCBS
2563633OtherUNITED
NC203242087OtherPHCS
NC5902336Medicaid
2046220Medicare PIN
2563633OtherUNITED