Provider Demographics
NPI:1144206632
Name:VARGA, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:VARGA
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 1:715 S COWLEY ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1375
Mailing Address - Country:US
Mailing Address - Phone:509-624-9217
Mailing Address - Fax:
Practice Address - Street 1:715 S COWLEY ST
Practice Address - Street 2:SUITE 228
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1375
Practice Address - Country:US
Practice Address - Phone:509-624-9217
Practice Address - Fax:509-623-2187
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00036941208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1106384Medicaid
WAGAB07330Medicare ID - Type Unspecified
WA1106384Medicaid
WAGAB07330Medicare PIN