Provider Demographics
NPI:1346475506
Name:VARUGHESE, SHIBU (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIBU
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1620 BELLE CHASSE HWY
Mailing Address - Street 2:STE101
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7057
Mailing Address - Country:US
Mailing Address - Phone:504-265-8304
Mailing Address - Fax:504-309-4193
Practice Address - Street 1:1620 BELLE CHASSE HWY
Practice Address - Street 2:STE101
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7057
Practice Address - Country:US
Practice Address - Phone:504-265-8304
Practice Address - Fax:504-309-4193
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31922183500000X
FLME104707207R00000X
LAMD203694207RG0300X, 207RH0002X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No183500000XPharmacy Service ProvidersPharmacist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2107780Medicaid
FLCQ321ZMedicare UPIN
LA2107780Medicaid