Provider Demographics
NPI:1659446391
Name:SPANAKI-VARELAS, MARIANNA VLASSIOU (MD)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:VLASSIOU
Last Name:SPANAKI-VARELAS
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 1:47 NEW SCOTLAND AVE # MC70
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-262-5274
Mailing Address - Fax:518-262-6261
Practice Address - Street 1:47 NEW SCOTLAND AVE # MC70
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-5274
Practice Address - Fax:518-262-6261
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010850682084N0400X
NY301283-012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI472435910Medicaid
130H264490OtherBLUE CROSS-BLUE CROSS
MS085068OtherCHAMPUS-CHAMPUS
MS085068OtherCOMMERCIAL-COMMERCIAL NUMBER