Provider Demographics
NPI:1730155391
Name:VERGHESE, MOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:
Last Name:VERGHESE
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 1:11412 CUSHMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3608
Mailing Address - Country:US
Mailing Address - Phone:301-984-6159
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:RM. C-2149
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2976
Practice Address - Country:US
Practice Address - Phone:202-877-3968
Practice Address - Fax:202-877-8113
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD14574208100000X, 208800000X
PAMD467181208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023408400Medicaid
DC007500726Medicaid
DC754921100Medicaid