Provider Demographics
NPI:1598932337
Name:VARGHESE, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:NINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8817 NIGHT WIND LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4989
Mailing Address - Country:US
Mailing Address - Phone:817-431-4404
Mailing Address - Fax:
Practice Address - Street 1:8817 NIGHT WIND LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4989
Practice Address - Country:US
Practice Address - Phone:817-431-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-051960207R00000X
TXN6746207R00000X
WAMD60126635207R00000X
FLME152991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine