Provider Demographics
NPI:1326259623
Name:MAMMEN, JOSHUA MATTHEW VARGHISE (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MATTHEW VARGHISE
Last Name:MAMMEN
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 1:986880 NEBRASKA MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-6880
Mailing Address - Country:US
Mailing Address - Phone:402-559-7298
Mailing Address - Fax:
Practice Address - Street 1:986880 NEBRASKA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-6880
Practice Address - Country:US
Practice Address - Phone:402-559-7298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM67402086X0206X
NE331532086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8AG961OtherBLUE CROSS BLUE SHIELD
8AG961OtherBLUE CROSS BLUE SHIELD