Provider Demographics
NPI:1588774244
Name:VARGAS, SOCORRO JUAN (MD)
Entity type:Individual
Prefix:
First Name:SOCORRO
Middle Name:JUAN
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOCORRO
Other - Middle Name:BENIGNO
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:114 WOODLAND ST
Mailing Address - Street 2:DEPARTMENT OF ENDOCRINOLOGY
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1208
Mailing Address - Country:US
Mailing Address - Phone:860-714-4285
Mailing Address - Fax:860-714-8086
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:DEPARTMENT OF ENDOCRINOLOGY
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-4285
Practice Address - Fax:860-714-8086
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026695207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1266956Medicaid
1824243OtherUNITED HEALTHCARE
2V5163OtherHEALTHNET
48749469OtherTRI-CARE
P3636054OtherOXFORD
010026695CT05OtherANTHEM BCBS
126695OtherCONNECTICARE
126695OtherCONNECTICARE
1824243OtherUNITED HEALTHCARE