Provider Demographics
NPI:1285384289
Name:VARELA, MIRA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MIRA
Middle Name:ELIZABETH
Last Name:VARELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRA
Other - Middle Name:ELIZABETH
Other - Last Name:NICCHITTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5960 FAIRVIEW RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3113
Mailing Address - Country:US
Mailing Address - Phone:704-918-1934
Mailing Address - Fax:
Practice Address - Street 1:10635 PARK RD STE I
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8408
Practice Address - Country:US
Practice Address - Phone:704-495-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2025-01091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program