Provider Demographics
NPI:1952390734
Name:VAROL, PNINIT (MD)
Entity Type:Individual
Prefix:
First Name:PNINIT
Middle Name:
Last Name:VAROL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PNINIT
Other - Middle Name:VAROL
Other - Last Name:EAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3715 NE TROUT BROOK LN
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 S KITSAP BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3709
Practice Address - Country:US
Practice Address - Phone:360-744-6275
Practice Address - Fax:360-744-6270
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054783A208000000X, 207R00000X
WAMD00048439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200466040Medicaid
INI06208Medicare UPIN
IN200466040Medicaid