Provider Demographics
NPI:1760589808
Name:VARLACK, CYRIL GERBETT (PA)
Entity Type:Individual
Prefix:
First Name:CYRIL
Middle Name:GERBETT
Last Name:VARLACK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:613 E ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5124
Practice Address - Country:US
Practice Address - Phone:704-283-8193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102489363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101179Medicaid
NC1760589808Medicaid
SC2315PAMedicaid
NC2751366CMedicare PIN
NC1760589808Medicaid
NC2751366EMedicare PIN
NC2751366JMedicare PIN
NC8101179Medicaid
NC2751366GMedicare PIN
NC2751366HMedicare PIN
SC2315PAMedicaid
NC2751366KMedicare PIN
NC2751366MMedicare PIN
NC2751366QMedicare PIN
NC2751366NMedicare PIN
NC2751366RMedicare PIN
NC2751336FMedicare PIN