Provider Demographics
| NPI: | 1053562967 |
|---|---|
| Name: | VARGA, STEPHEN EARL (MD) |
| Entity type: | Individual |
| Prefix: | DR |
| First Name: | STEPHEN |
| Middle Name: | EARL |
| Last Name: | VARGA |
| Suffix: | |
| Gender: | M |
| Credentials: | MD |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 1200 N VEITCH ST |
| Mailing Address - Street 2: | APT 1135 |
| Mailing Address - City: | ARLINGTON |
| Mailing Address - State: | VA |
| Mailing Address - Zip Code: | 22201-5818 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 8260 WILLOW OAKS CORPORATE DR STE 600 |
| Practice Address - Street 2: | |
| Practice Address - City: | FAIRFAX |
| Practice Address - State: | VA |
| Practice Address - Zip Code: | 22031-4528 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 571-472-4670 |
| Practice Address - Fax: | 571-665-6798 |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2008-10-09 |
| Last Update Date: | 2022-12-05 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CA | A11662 | 208600000X |
| PA | MD459746 | 208600000X |
| VA | 0101265513 | 2086S0102X, 208600000X |
| 390200000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | |
| No | 2086S0102X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
| No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |