Provider Demographics
NPI:1841380284
Name:VARGHESE, JOGY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOGY
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4163 LOMAC ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2881
Mailing Address - Country:US
Mailing Address - Phone:337-396-5570
Mailing Address - Fax:334-396-5572
Practice Address - Street 1:4163 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2881
Practice Address - Country:US
Practice Address - Phone:334-396-5570
Practice Address - Fax:334-396-5572
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17288207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009995115Medicaid
AL009991675Medicaid
AL009991665Medicaid
ALK382OtherMEDICARE GROUP NUMBER
AL009991665Medicaid
AL009995115Medicaid