Healthcare Provider Details

I. General information

NPI: 1205853272
Provider Name (Legal Business Name): MARK A VARVARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHARLES ST
BOSTON MA
02114-3002
US

IV. Provider business mailing address

243 CHARLES ST
BOSTON MA
02114-3002
US

V. Phone/Fax

Practice location:
  • Phone: 617-523-7900
  • Fax:
Mailing address:
  • Phone: 617-523-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number74200
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number74200
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: