Provider Demographics
NPI:1992858567
Name:VARGHESE, PRAYMOL
Entity Type:Individual
Prefix:DR
First Name:PRAYMOL
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PRAYMOL
Other - Middle Name:
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13128 BRUSHWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1025
Mailing Address - Country:US
Mailing Address - Phone:301-990-6653
Mailing Address - Fax:301-977-5930
Practice Address - Street 1:8929 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1308
Practice Address - Country:US
Practice Address - Phone:301-990-6653
Practice Address - Fax:301-977-5930
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00281822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD53407706OtherBLUE CROSS BLUE SHIELD
MD222721500Medicaid
MD453357OtherMAMSI
MD53407706OtherBLUE CROSS BLUE SHIELD
DC491624Medicare PIN