Provider Demographics
NPI:1356554349
Name:VARGHESE, RENITA BUTLER (MD)
Entity type:Individual
Prefix:DR
First Name:RENITA
Middle Name:BUTLER
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RENITA
Other - Middle Name:DENELLE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:2727 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1669
Practice Address - Country:US
Practice Address - Phone:713-442-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM91852085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289969205Medicaid
TX289969204Medicaid
TX289969206Medicaid
CADC041PMedicare PIN
CADC041SMedicare PIN
CADC041XMedicare PIN
CADC041UMedicare PIN
TX272235YKTUMedicare PIN
TX2899692-01Medicaid
TXTXB136643Medicare PIN
CADC041TMedicare PIN
CADC041VMedicare PIN
TX289969205Medicaid
CADC041QMedicare PIN
CADC041RMedicare PIN
CADC041WMedicare PIN
CADC041ZMedicare PIN
TX272235YKTVMedicare PIN