Provider Demographics
NPI:1790713782
Name:VERGHESE & LING M.D.P.A.
Entity Type:Organization
Organization Name:VERGHESE & LING M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KANNARKAT
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-475-8091
Mailing Address - Street 1:PO BOX 1409
Mailing Address - Street 2:26840 POINT LOOKOUT ROAD
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1409
Mailing Address - Country:US
Mailing Address - Phone:301-475-8091
Mailing Address - Fax:301-475-6712
Practice Address - Street 1:24035 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-4871
Practice Address - Country:US
Practice Address - Phone:301-373-7730
Practice Address - Fax:301-373-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0005718207K00000X
MDD0044371207N00000X
MDD0015709207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD432981300Medicaid
MDDC1697OtherMEDICARE RAILROAD
MD432981300Medicaid