Provider Demographics
NPI:1548207848
Name:VARUGHESE, LIZY (MD)
Entity Type:Individual
Prefix:
First Name:LIZY
Middle Name:
Last Name:VARUGHESE
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1600 FM 544 STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4591
Practice Address - Country:US
Practice Address - Phone:972-316-7400
Practice Address - Fax:972-316-0907
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235936208000000X
TXP3829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY666Y61OtherEMPIRE BC.BS
NY7667699OtherAETNA
NY02666342Medicaid
NY7667699OtherAETNA
NY661X31Medicare ID - Type Unspecified