Provider Demographics
NPI:1821044496
Name:VARALLO, GERARDO (DO)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:VARALLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LAUREL OAK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4424
Mailing Address - Country:US
Mailing Address - Phone:856-566-5478
Mailing Address - Fax:856-566-9561
Practice Address - Street 1:201 LAUREL OAK RD
Practice Address - Street 2:SUITE B
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4424
Practice Address - Country:US
Practice Address - Phone:856-566-5478
Practice Address - Fax:856-566-9561
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07563500207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0129160Medicaid
NJI53084Medicare UPIN
NJPENDINGMedicare ID - Type Unspecified