MEDICARE: DR. DEIDRA L. VARNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0033512	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	058050000	OTHER	MD	PREFERRED HEALTH
2	42219503	OTHER	MD	BCBS OF MARYLAND
3	7213045013	OTHER	MD	CIGNA
4	25970024	OTHER	DC	BCBSNCA
5	263126	OTHER	MD	ALLIANCE
6	498202	OTHER	MD	NCPPO
7	115479	OTHER	MD	KAISER
8	2088208	OTHER	MD	AETNA US HEALTHCARE
9	2500913	OTHER	MD	UNTD HLTHC AMERI CHOICE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	521973185	OTHER	MD	FIDELITY PMG
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	2501191	OTHER	MD	EVERCARE
14	4356542	OTHER	MD	AETNA
15	463126	OTHER	MD	MAMSI
16	521973185	OTHER	MD	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1255399671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEIDRA L. VARNER M.D.

Provider Business Mailing Address
First Line	:	1509 PEACHTREE COURT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11701 LIVINGSTON RD
Second Line	:	SUITE 203
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5104
Country	:	US
Telephone Number	:	301-292-7270
Fax Number	:	301-203-0740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	04/02/2009

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