Basic Information
| Provider Information | |||||||||
| NPI: | 1184607525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARELA | ||||||||
| FirstName: | CARLY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N 20TH ST STE 301 | ||||||||
| Address2: | CHCA | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191031454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155672422 | ||||||||
| FaxNumber: | 2155610959 | ||||||||
| Practice Location | |||||||||
| Address1: | CHILDREN'S NATIONAL HEALTH SYSTEM | ||||||||
| Address2: | 111 MICHIGAN AVE NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024764000 | ||||||||
| FaxNumber: | 7035311590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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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 | 208000000X | MD428392 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 043287 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0207X | MD428392 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 001432872 | 05 | CT | MEDICAID |