Provider Demographics
NPI:1134196017
Name:VARGO, MATTHEW A (CRNA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:VARGO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13113 ATKINS CIRCLE DR
Mailing Address - Street 2:APT 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3777
Mailing Address - Country:US
Mailing Address - Phone:704-384-4274
Mailing Address - Fax:704-384-5636
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-4239
Practice Address - Fax:704-384-5636
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN116871367500000X
TNRN101773367500000X
TNAPN10846367500000X
NC070172367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN363218Medicaid
SCNAN817Medicaid
SCNAN817Medicaid
NC2619181Medicare PIN
SCQ34843Medicare PIN
TN363218Medicaid
SCQ348433365Medicare PIN
TN3633218Medicare PIN