Healthcare Provider Details

I. General information

NPI: 1396248357
Provider Name (Legal Business Name): ETHAN VARNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W LOCUST ST
WILMINGTON OH
45177-2572
US

IV. Provider business mailing address

1150 W LOCUST ST
WILMINGTON OH
45177-2572
US

V. Phone/Fax

Practice location:
  • Phone: 937-535-7878
  • Fax:
Mailing address:
  • Phone: 937-535-7878
  • Fax: 513-487-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.155853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: