Provider Demographics
NPI:1639393291
Name:VARGHESE, CARA (PA)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GERMANTOWN RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5036
Mailing Address - Country:US
Mailing Address - Phone:203-794-0090
Mailing Address - Fax:203-830-4614
Practice Address - Street 1:25 GERMANTOWN RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5036
Practice Address - Country:US
Practice Address - Phone:203-794-0090
Practice Address - Fax:203-830-4614
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00072700363A00000X, 363AM0700X
CT002140363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
064228Medicare ID - Type Unspecified
P72042Medicare UPIN