1871317503 NPI number — EROTOKRITOS TERRY VARLAS DPT

Table of content: EROTOKRITOS TERRY VARLAS DPT (NPI 1871317503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871317503 NPI number — EROTOKRITOS TERRY VARLAS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARLAS
Provider First Name:
EROTOKRITOS
Provider Middle Name:
TERRY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VARLAS
Provider Other First Name:
ERIC
Provider Other Middle Name:
TERRY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871317503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2404 VIDALIA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20601-3780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-233-9193
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CENTENNIAL ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PLATA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20646-5976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-392-3700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)