Basic Information
Provider Information | |||||||||
NPI: | 1174513709 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VARMA | ||||||||
FirstName: | JAY | ||||||||
MiddleName: | D | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2722 MERRILEE DR | ||||||||
Address2: | STE 230 | ||||||||
City: | FAIRFAX | ||||||||
State: | VA | ||||||||
PostalCode: | 220314400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7036984483 | ||||||||
FaxNumber: | 7035730880 | ||||||||
Practice Location | |||||||||
Address1: | 2722 MERRILEE DR | ||||||||
Address2: | STE 230 | ||||||||
City: | FAIRFAX | ||||||||
State: | VA | ||||||||
PostalCode: | 220314400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7036984483 | ||||||||
FaxNumber: | 7035730880 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/25/2005 | ||||||||
LastUpdateDate: | 01/16/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD33476 | DC | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 0101235651 | VA | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 0101235651 | VA | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
ID | Type | State | Issuer | Description | 7413329 | 01 | VA | AETNA | OTHER | 0095 | 01 | VA | CAREFIRST BCBS | OTHER | 227984 | 01 | VA | KAISER | OTHER | 1501603 | 01 | VA | AETNA HMO | OTHER | 7340755 | 01 |   | CIGNA | OTHER |