Provider Demographics
NPI:1255399671
Name:VARNER, DEIDRA L (MD)
Entity type:Individual
Prefix:DR
First Name:DEIDRA
Middle Name:L
Last Name:VARNER
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 1:1509 PEACHTREE COURT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11701 LIVINGSTON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5104
Practice Address - Country:US
Practice Address - Phone:301-292-7270
Practice Address - Fax:301-203-0740
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058050000OtherPREFERRED HEALTH
MD42219503OtherBCBS OF MARYLAND
MD7213045013OtherCIGNA
DC25970024OtherBCBSNCA
MD263126OtherALLIANCE
MD498202OtherNCPPO
MD115479OtherKAISER
MD2088208OtherAETNA US HEALTHCARE
MD2500913OtherUNTD HLTHC AMERI CHOICE
MD481001500Medicaid
MD521973185OtherFIDELITY PMG
DC408340Medicaid
MD2501191OtherEVERCARE
MD4356542OtherAETNA
MD463126OtherMAMSI
MD521973185OtherUNITED HEALTHCARE
MD521973185OtherFIDELITY PMG
MD2500913OtherUNTD HLTHC AMERI CHOICE
MD481001500Medicaid
MD454LM995Medicare PIN
DC002508M92Medicare PIN
MD110178491Medicare PIN