MARK A VARALLO
Physician/surgeon


Address: 670 Davidson Rd, Lockport, NY 14094

MARK A VARALLO (Credential# 550732) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is August 5, 1996. The license expiration date date is July 31, 1997. The license status is INACTIVE.

Business Overview

MARK A VARALLO is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.033133. The credential type is physician/surgeon. The effective date is August 5, 1996. The expiration date is July 31, 1997. The business address is 670 Davidson Rd, Lockport, NY 14094. The current status is inactive.

Basic Information

Licensee Name MARK A VARALLO
Credential ID 550732
Credential Number 1.033133
Credential Type Physician/Surgeon
Business Address 670 Davidson Rd
Lockport
NY 14094
Business Type INDIVIDUAL
Status INACTIVE - LAPSED DUE TO NON-RENEWAL
Issue Date 1993-07-09
Effective Date 1996-08-05
Expiration Date 1997-07-31
Refresh Date 2009-07-08

Other licenses

ID Credential Code Credential Type Issue Term Status
163780 CSP.0021257 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 1995-04-27 - 1996-02-28 INACTIVE

Office Location

Street Address 670 DAVIDSON RD
City LOCKPORT
State NY
Zip Code 14094

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Mitchel Swan 5809 Constock Rd., Lockport, NY 14094 Hoisting Equipment Operator 2004-04-02 ~ 2006-04-01
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Competitor

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City LOCKPORT
Zip Code 14094
License Type Physician/Surgeon
License Type + County Physician/Surgeon + LOCKPORT

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Dataset Information

Data Provider Connecticut Department of Consumer Protection
Jurisdiction Connecticut
Related Datasets Connecticut Business Registrations, Connecticut Child Care Facilities

This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).

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