Provider Demographics
NPI:1073671376
Name:VARVERIS, NICHOLAS C (DPM)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:C
Last Name:VARVERIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 CEMETERY RD.
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1641
Mailing Address - Country:US
Mailing Address - Phone:614-771-1107
Mailing Address - Fax:614-771-0429
Practice Address - Street 1:4975 CEMETERY RD.
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1641
Practice Address - Country:US
Practice Address - Phone:614-771-1107
Practice Address - Fax:614-771-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002083213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0489805Medicaid
OH0489805Medicaid
OH1090090001Medicare NSC