Provider Demographics
NPI:1417107293
Name:BABY, VARUGHESE MAX (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:VARUGHESE
Middle Name:MAX
Last Name:BABY
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 HIDDEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1651
Mailing Address - Country:US
Mailing Address - Phone:516-749-3845
Mailing Address - Fax:
Practice Address - Street 1:4314 YOAKUM BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5818
Practice Address - Country:US
Practice Address - Phone:713-850-0049
Practice Address - Fax:713-850-0036
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY525591390200000X
TX781646363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215863603Medicaid
TX215863602Medicaid
TX215863605Medicaid
TXP00967678OtherRAIL ROAD MCR DALLAS
TX859N32OtherBCBS TX
TX215863604Medicaid
TXP00889009OtherRAIL ROAD MEDICARE
TX834N18OtherBCBS TX
TX215863601Medicaid
TX847N28OtherBCBS TX
TXTXB150673Medicare PIN
TXTXB152878Medicare PIN
TX834N18OtherBCBS TX
TX215863602Medicaid
TX215863604Medicaid
TXTXB110896Medicare PIN