Provider Demographics
NPI:1154370559
Name:VARGHESE, VINNY M (MD)
Entity type:Individual
Prefix:
First Name:VINNY
Middle Name:M
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 REBECCA LN
Mailing Address - Street 2:2
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:386-228-3636
Practice Address - Street 1:2720 REBECCA LN
Practice Address - Street 2:2
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:386-228-3636
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17184YOtherMEDICARE INDIVIDUAL PTAN
FLAH745OtherMEDICARE GROUP PTAN
FLH72731Medicare UPIN