Basic Information
| Provider Information | |||||||||
| NPI: | 1013408210 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARAKIN | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1022 LEE ANN DR NE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048861918 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 MILLS AVE | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642323668 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 744 | SC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | 744 | SC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 390200000X | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 213EP1101X | 744 | SC | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
No ID Information.