Provider Demographics
NPI:1720570716
Name:THOMAS, SAM VARGHESE (DO)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:VARGHESE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4755 OGLETOWN STANTON RD STE 2E70
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-3475
Mailing Address - Fax:302-733-6082
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 2E70
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-3475
Practice Address - Fax:302-733-6082
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0024482207RP1001X, 207RC0200X, 207R00000X
NJ25MB11327000207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine