Provider Demographics
NPI:1811179872
Name:VINNY M VARGHESE MD PA
Entity type:Organization
Organization Name:VINNY M VARGHESE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANJALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-228-1234
Mailing Address - Street 1:2720 REBECCA LN STE 2
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8351
Mailing Address - Country:US
Mailing Address - Phone:386-228-1234
Mailing Address - Fax:
Practice Address - Street 1:2720 REBECCA LN STE 2
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8351
Practice Address - Country:US
Practice Address - Phone:386-228-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-02
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17184YOtherMEDICARE INDIVIDUAL PTAN
FLAH745OtherMEDICARE GROUP PTAN
FLAH745OtherMEDICARE GROUP PTAN