Provider Demographics
NPI:1790756740
Name:VARNEY, LEROY BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:BRIAN
Last Name:VARNEY
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 1:2318 E MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9351
Mailing Address - Country:US
Mailing Address - Phone:740-653-7121
Mailing Address - Fax:740-653-7122
Practice Address - Street 1:2318 E MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9351
Practice Address - Country:US
Practice Address - Phone:740-653-7121
Practice Address - Fax:740-653-7122
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-29
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430462Medicaid
OHH95512Medicare UPIN
OHVA4118041Medicare ID - Type Unspecified