Provider Demographics
NPI:1356355648
Name:VARANASI, JAYADEEP SRINIVAS (MD)
Entity type:Individual
Prefix:DR
First Name:JAYADEEP
Middle Name:SRINIVAS
Last Name:VARANASI
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 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:336-275-4096
Mailing Address - Fax:336-274-5021
Practice Address - Street 1:1126 N CHURCH ST STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1037
Practice Address - Country:US
Practice Address - Phone:336-938-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100289207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC191261OtherMEDCOST
NC5904871Medicaid
NC808208OtherPARTNERS
NC1301HOtherBCBS OF NC
NC5904871Medicaid
NC2061153Medicare PIN
NCH55043Medicare UPIN