Provider Demographics
NPI:1063473122
Name:VARNEDORE, BIRDIE M (MD)
Entity Type:Individual
Prefix:
First Name:BIRDIE
Middle Name:M
Last Name:VARNEDORE
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 1:2823 NORTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7912
Mailing Address - Country:US
Mailing Address - Phone:407-754-6490
Mailing Address - Fax:407-512-4050
Practice Address - Street 1:7727 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8224
Practice Address - Country:US
Practice Address - Phone:407-754-6490
Practice Address - Fax:407-512-4050
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME899882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271065000Medicaid
FL271065000Medicaid
FLU3737ZMedicare PIN