Provider Demographics
NPI:1508831207
Name:VARGO, KATHRYN M (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
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 1:10 ALICE PECK DAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2694
Mailing Address - Country:US
Mailing Address - Phone:603-448-3121
Mailing Address - Fax:603-448-7462
Practice Address - Street 1:141 MASCOMA ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2647
Practice Address - Country:US
Practice Address - Phone:603-448-3996
Practice Address - Fax:603-448-6863
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10146207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011237Medicaid
NH16P030OtherMVP
NHVARG161879OtherANTHEM
VT0RE4581Medicaid
VT00029801OtherBLUE CROSS/SHIELD VT
NHRE4581Medicare ID - Type Unspecified
NHG56738Medicare UPIN