Healthcare Provider Details

I. General information

NPI: 1528877156
Provider Name (Legal Business Name): DIEGO VARELA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24560 SOUTHPOINT DR STE 120
ALDIE VA
20105-3505
US

IV. Provider business mailing address

24560 SOUTHPOINT DR STE 120
ALDIE VA
20105-3505
US

V. Phone/Fax

Practice location:
  • Phone: 703-348-5060
  • Fax:
Mailing address:
  • Phone: 703-348-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0110011983
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: