Provider Demographics
NPI:1003858515
Name:VARVITSIOTIS, POSEIDON SPYROS (MD)
Entity Type:Individual
Prefix:
First Name:POSEIDON
Middle Name:SPYROS
Last Name:VARVITSIOTIS
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 1:1631 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4728
Mailing Address - Country:US
Mailing Address - Phone:505-988-3975
Mailing Address - Fax:505-986-8001
Practice Address - Street 1:1631 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4728
Practice Address - Country:US
Practice Address - Phone:505-988-3975
Practice Address - Fax:505-986-8001
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-397208600000X
NM97--397208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000R6782Medicaid
NM000R6782Medicaid
NMG58727Medicare UPIN