Provider Demographics
NPI:1568540904
Name:VARELA, LORRAINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:VARELA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 MEDFORD MOUNT HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9642
Mailing Address - Country:US
Mailing Address - Phone:609-654-4364
Mailing Address - Fax:
Practice Address - Street 1:77 PEMBERTON BROWNS MILLS RD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015
Practice Address - Country:US
Practice Address - Phone:609-893-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01782213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1795902Medicaid
NJVA536552Medicare ID - Type Unspecified
NJ1795902Medicaid