Provider Demographics
NPI:1568750180
Name:VARILLA, VINCENT MARANAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:MARANAN
Last Name:VARILLA
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 1:73 WATERBURY RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1252
Mailing Address - Country:US
Mailing Address - Phone:860-714-4749
Mailing Address - Fax:860-714-8439
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 2112
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-4749
Practice Address - Fax:860-714-8439
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54433207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine