Basic Information
| Provider Information | |||||||||
| NPI: | 1255399671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARNER | ||||||||
| FirstName: | DEIDRA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1509 PEACHTREE COURT | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20721 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11701 LIVINGSTON RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207445104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012927270 | ||||||||
| FaxNumber: | 3012030740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 04/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0033512 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 058050000 | 01 | MD | PREFERRED HEALTH | OTHER | 42219503 | 01 | MD | BCBS OF MARYLAND | OTHER | 7213045013 | 01 | MD | CIGNA | OTHER | 25970024 | 01 | DC | BCBSNCA | OTHER | 263126 | 01 | MD | ALLIANCE | OTHER | 498202 | 01 | MD | NCPPO | OTHER | 115479 | 01 | MD | KAISER | OTHER | 2088208 | 01 | MD | AETNA US HEALTHCARE | OTHER | 2500913 | 01 | MD | UNTD HLTHC AMERI CHOICE | OTHER | 481001500 | 05 | MD | MEDICAID | 521973185 | 01 | MD | FIDELITY PMG | OTHER | 408340 | 05 | DC | MEDICAID | 2501191 | 01 | MD | EVERCARE | OTHER | 4356542 | 01 | MD | AETNA | OTHER | 463126 | 01 | MD | MAMSI | OTHER | 521973185 | 01 | MD | UNITED HEALTHCARE | OTHER |