Provider Demographics
NPI:1619747243
Name:VARVEL, RYAN SCOTT (SO-IDC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:SCOTT
Last Name:VARVEL
Suffix:
Gender:M
Credentials:SO-IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 MCKAYLA RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5377
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2D RECONNAISSANCE BN
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE PSC BOX 20138
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:336-858-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman