Provider Demographics
NPI:1457369357
Name:VARHOL, STEPHEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:VARHOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S
Other - Middle Name:GREGORY
Other - Last Name:VARHOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:215 OLD TAPPAN ROAD
Mailing Address - Street 2:OLD TAPPAN MEDICAL GROUP
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-666-1000
Mailing Address - Fax:201-666-7610
Practice Address - Street 1:215 OLD TAPPAN ROAD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-1000
Practice Address - Fax:201-666-7610
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02920800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010029208NJ01OtherANTHEM HEALTH
1491826OtherUNITEDHLTHCR
NJ4749308Medicaid
80603OtherAMERIGROUP
998608OtherREFERRAL
23811OtherMASTERCARE
BP035OtherOXFORD
F01393OtherHEALTHNET
973431OtherEMPIRE HLTHCR
13348OtherUSHC
221941517002OtherPRUDENTIAL
4218300OtherAETNA
BP035OtherOXFORD
NJ4749308Medicaid