Provider Demographics
NPI:1326308891
Name:VARKEY, DAX THATTACUNNEL (MD)
Entity Type:Individual
Prefix:
First Name:DAX
Middle Name:THATTACUNNEL
Last Name:VARKEY
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 1:1130 N CHURCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1041
Mailing Address - Country:US
Mailing Address - Phone:336-375-2300
Mailing Address - Fax:336-375-2314
Practice Address - Street 1:1130 N CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-375-2300
Practice Address - Fax:336-375-2314
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-00582207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326308891Medicaid
NC2017-00582OtherMEDICAL LICENSE
SCNC3018Medicaid
NC0397730007OtherNSC #