Healthcare Provider Details

I. General information

NPI: 1275506388
Provider Name (Legal Business Name): KARIN R VARBLOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARIN R FORMAN MD

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 VINCENT PL
MC LEAN VA
22101-3615
US

IV. Provider business mailing address

1319 VINCENT PL
MC LEAN VA
22101-3615
US

V. Phone/Fax

Practice location:
  • Phone: 703-996-4737
  • Fax: 703-996-4737
Mailing address:
  • Phone: 703-996-4737
  • Fax: 703-996-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101102760
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: