Provider Demographics
NPI:1730103268
Name:VARNER, JAMES PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PHILLIP
Last Name:VARNER
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 1:2324 WASHINGTON ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021
Mailing Address - Country:US
Mailing Address - Phone:781-591-9133
Mailing Address - Fax:
Practice Address - Street 1:2324 WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1159
Practice Address - Country:US
Practice Address - Phone:781-591-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45226207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ13342OtherBLUE CROSS & BLUE SHIELD
MA045226OtherTUFTS HEALTH PLAN
MA3103846Medicaid
MA045226OtherTUFTS HEALTH PLAN