Healthcare Provider Details

I. General information

NPI: 1821389768
Provider Name (Legal Business Name): CHRISTOPHER PAUL VARACALLO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S MAIN ST
DU BOIS PA
15801-1413
US

IV. Provider business mailing address

621 S MAIN ST
DU BOIS PA
15801-1413
US

V. Phone/Fax

Practice location:
  • Phone: 814-299-7520
  • Fax:
Mailing address:
  • Phone: 814-299-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS017464
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS017464
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: