Provider Demographics
NPI:1982240636
Name:VARGHESE, REKHA (PA-C)
Entity Type:Individual
Prefix:
First Name:REKHA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5558
Mailing Address - Country:US
Mailing Address - Phone:847-736-4173
Mailing Address - Fax:
Practice Address - Street 1:301 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7335
Practice Address - Country:US
Practice Address - Phone:732-281-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant