Provider Demographics
NPI:1538139266
Name:VARGHESE, ROY (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KATE IRELAND DR
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749
Mailing Address - Country:US
Mailing Address - Phone:606-672-2901
Mailing Address - Fax:606-672-3626
Practice Address - Street 1:130 KATE IRELAND DR
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749
Practice Address - Country:US
Practice Address - Phone:606-672-2901
Practice Address - Fax:606-672-3626
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18866207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1114590OtherPASSPORT
KY164134000OtherFEDERAL WORKERS COMP
KY110172171OtherRAILROAD MEDICARE
KY1532292OtherUMWA/FUNDS
KY64188667Medicaid
KY000000051979OtherBLUE CROSS BLUE SHIELD
KY020082000OtherDEPARTMENT OF LABOR
KY1532292OtherUMWA/FUNDS
KY64188667Medicaid
KYC68043Medicare ID - Type Unspecified