Provider Demographics
NPI:1518082577
Name:VARAKLIS, KALLIOPE (MD)
Entity Type:Individual
Prefix:
First Name:KALLIOPE
Middle Name:
Last Name:VARAKLIS
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 1:22 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6143
Practice Address - Country:US
Practice Address - Phone:207-761-0650
Practice Address - Fax:207-761-8198
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD16598207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G22283Medicare UPIN
MEME083201Medicare PIN
MEME083202Medicare PIN