Provider Demographics
NPI:1407890726
Name:VARLOTTA, LAURIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:VARLOTTA
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 1:1237 ARWYN LN
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1414
Mailing Address - Country:US
Mailing Address - Phone:610-896-6438
Mailing Address - Fax:610-896-7487
Practice Address - Street 1:1237 ARWYN LN
Practice Address - Street 2:
Practice Address - City:GLADWYNE
Practice Address - State:PA
Practice Address - Zip Code:19035-1414
Practice Address - Country:US
Practice Address - Phone:610-212-2689
Practice Address - Fax:610-896-7487
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044256E208000000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012822900001Medicaid
PA720580Medicare ID - Type Unspecified
PA0012822900001Medicaid