Provider Demographics
NPI:1598852667
Name:VARGHESE, MATHEW C (MD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:C
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 1:4037 DEL PRADO BLVD S FL 33904
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7162
Mailing Address - Country:US
Mailing Address - Phone:917-882-5359
Mailing Address - Fax:239-895-9903
Practice Address - Street 1:4037 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7162
Practice Address - Country:US
Practice Address - Phone:239-316-3839
Practice Address - Fax:239-895-9903
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146302208000000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00742347Medicaid
NY00E181Medicare ID - Type Unspecified
NY00742347Medicaid