Provider Demographics
NPI:1790713782
Name:VERGHESE & LING M.D.P.A.
Entity type:Organization
Organization Name:VERGHESE & LING M.D.P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:KANNARKAT
Authorized Official - Last Name:VERGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-396-3401
Mailing Address - Street 1:173 SAINT PATRICKS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5531
Mailing Address - Country:US
Mailing Address - Phone:301-396-3401
Mailing Address - Fax:301-396-3404
Practice Address - Street 1:26840 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:301-396-3401
Practice Address - Fax:301-396-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ND0101X, 207N00000X
MDD0015709207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDC1697OtherMEDICARE RAILROAD
MD432981300Medicaid
MD432981300Medicaid