Provider Demographics
NPI:1457464166
Name:VARUGHESE, MARY M (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CERARRD
Mailing Address - Street 2:
Mailing Address - City:E.NORTH PORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731
Mailing Address - Country:US
Mailing Address - Phone:631-368-2037
Mailing Address - Fax:631-368-1247
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:VAMC,NORTH PORT
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-754-7968
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303063363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner