Provider Demographics
NPI:1477819985
Name:VARGO, ADRIENNE (MD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:VARGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 4TH ST. E.
Mailing Address - Street 2:STE. 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101
Mailing Address - Country:US
Mailing Address - Phone:651-292-2000
Mailing Address - Fax:651-292-2136
Practice Address - Street 1:250 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-292-2000
Practice Address - Fax:651-292-2136
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361299822085R0202X
PAMD4487812085R0202X
MN647882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology