Provider Demographics
NPI:1649600222
Name:TONY VARGHESE MD PA., LLC
Entity Type:Organization
Organization Name:TONY VARGHESE MD PA., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-383-2072
Mailing Address - Street 1:19 FONTANA LN
Mailing Address - Street 2:STE.208
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3047
Mailing Address - Country:US
Mailing Address - Phone:410-574-4720
Mailing Address - Fax:
Practice Address - Street 1:19 FONTANA LN
Practice Address - Street 2:STE.208
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3047
Practice Address - Country:US
Practice Address - Phone:410-574-4720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064559207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty