Provider Demographics
NPI:1659358992
Name:VARANO, KENNETH J (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:VARANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E ELM ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4150
Mailing Address - Country:US
Mailing Address - Phone:215-892-1230
Mailing Address - Fax:610-910-3890
Practice Address - Street 1:125 E ELM ST STE 201
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-4150
Practice Address - Country:US
Practice Address - Phone:215-892-1230
Practice Address - Fax:610-910-3890
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009028 L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016323600005Medicaid
PA0016323600005Medicaid
PA692144Medicare PIN