=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033497698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMZI BARNABA VARELDZIS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2011
-----------------------------------------------------
Last Update Date | 05/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1850 CHADWICK DR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-376-2022
-----------------------------------------------------
Fax | 601-376-1816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1542 TULANE AVE RM 330A
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70112-2865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-568-8655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 301705
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------