Provider Demographics
NPI:1114580727
Name:VARUGHESE, DEEPAM SHAJI (MD)
Entity Type:Individual
Prefix:
First Name:DEEPAM
Middle Name:SHAJI
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPAM
Other - Middle Name:SHAJI
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8520 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7716
Mailing Address - Country:US
Mailing Address - Phone:281-485-4050
Mailing Address - Fax:
Practice Address - Street 1:8520 BROADWAY ST STE 200
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7716
Practice Address - Country:US
Practice Address - Phone:281-485-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT6272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine