Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | MD01782 | NJ |
NPI | 1568540904 |
---|---|
Provider Name | Dr. Lorraine Varela |
First Address | Medford, NJ 08055-9642 |
Second Address | Browns Mills, NJ 08015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1795902 | (05) | NJ |
T73050 | (02) | NJ |