Provider Demographics
NPI:1639146897
Name:PUTHENVEETIL, JOHN VARKEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VARKEY
Last Name:PUTHENVEETIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1041 NOELL LN STE 105
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2055
Practice Address - Country:US
Practice Address - Phone:252-451-2700
Practice Address - Fax:252-451-2702
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC17136207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110183301OtherMEDICARE RAILROAD
NCNC5040G818OtherINTERNAL MEDICINE CARDIOVASCULAR DISEASE
NC69545OtherBCBS
NC8969545Medicaid
NC69545OtherBCBS