Provider Demographics
NPI:1992865448
Name:VARGHESE, TONY (MD)
Entity Type:Individual
Prefix:
First Name:TONY
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 1:821 N EUTAW STREET
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BALTIMORE
Mailing Address - State:ME
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-383-2072
Mailing Address - Fax:410-669-6067
Practice Address - Street 1:821 N EUTAW STREET
Practice Address - Street 2:SUITE 308
Practice Address - City:BALTIMORE
Practice Address - State:ME
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-383-2072
Practice Address - Fax:410-669-6067
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD901901400Medicaid
KAN7SHOtherBCBS
MD901901400Medicaid