Provider Demographics
NPI:1316145808
Name:VARGHESE, VINCENT (DO)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GREENTREE CENTER
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:609-820-2430
Mailing Address - Fax:609-939-1985
Practice Address - Street 1:5 GREENTREE CENTER
Practice Address - Street 2:SUITE 117
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:609-820-2430
Practice Address - Fax:609-939-1985
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0009902207RC0000X
NJ25MB08266000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1316145808Medicaid