Provider Demographics
NPI:1619640356
Name:VARGHESE, SUNITHA SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNITHA
Middle Name:SUSAN
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:424 ALTA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5609
Mailing Address - Country:US
Mailing Address - Phone:361-443-9977
Mailing Address - Fax:
Practice Address - Street 1:YALE GAMMA KNIFE CENTER, SMILOW CANCER HOSPITAL
Practice Address - Street 2:35 PARK STREET, STE LOWER LEVEL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-785-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101180402085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology