Basic Information
| Provider Information | |||||||||
| NPI: | 1326308891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARKEY | ||||||||
| FirstName: | DAX | ||||||||
| MiddleName: | THATTACUNNEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 N CHURCH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363752300 | ||||||||
| FaxNumber: | 3363752314 | ||||||||
| Practice Location | |||||||||
| Address1: | 1130 N CHURCH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363752300 | ||||||||
| FaxNumber: | 3363752314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2012 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2017-00582 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1326308891 | 05 | NC | MEDICAID | 2017-00582 | 01 | NC | MEDICAL LICENSE | OTHER | NC3018 | 05 | SC | MEDICAID | 0397730007 | 01 | NC | NSC # | OTHER |