Provider Demographics
NPI:1508827676
Name:BIRDIE VARNEDORE MD, P.A.
Entity Type:Organization
Organization Name:BIRDIE VARNEDORE MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BIRDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNEDORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-754-6490
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 1:2823 NORTHAMPTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7912
Practice Address - Country:US
Practice Address - Phone:407-754-6490
Practice Address - Fax:407-512-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271065000Medicaid
FLU3737ZMedicare ID - Type Unspecified
FLI20539Medicare UPIN