Provider Demographics
NPI:1528075686
Name:VARGHESE, KOCHUPARAMPIL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:KOCHUPARAMPIL
Middle Name:THOMAS
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:K
Other - Middle Name:THOMAS
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1704 N HAMPTON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:972-224-7777
Mailing Address - Fax:972-224-7779
Practice Address - Street 1:1704 N HAMPTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8623
Practice Address - Country:US
Practice Address - Phone:972-224-7777
Practice Address - Fax:972-224-7779
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG92402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122942901Medicaid
TX00DW09Medicare ID - Type Unspecified