Provider Demographics
NPI:1518071638
Name:VARELA, CHARLES D (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
Last Name:VARELA
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:PO BOX 1580
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-1580
Mailing Address - Country:US
Mailing Address - Phone:870-269-8300
Mailing Address - Fax:870-269-5630
Practice Address - Street 1:2110 EAST MAIN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560
Practice Address - Country:US
Practice Address - Phone:870-269-8300
Practice Address - Fax:870-269-5630
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0781207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128893001Medicaid
AR200030482OtherMEDICARE RAILROAD
AR18528000000OtherQUAL CHOICE PROVIDER #
AR200030482OtherMEDICARE RAILROAD
AR5J956Medicare ID - Type UnspecifiedPROVIDER #