Provider Demographics
NPI:1972958452
Name:VARGHESE, LINCY (DO)
Entity type:Individual
Prefix:
First Name:LINCY
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:888-247-0125
Mailing Address - Fax:918-502-8001
Practice Address - Street 1:140 W 151ST ST S STE 202
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-4530
Practice Address - Country:US
Practice Address - Phone:918-478-6005
Practice Address - Fax:918-321-7415
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXS2529208000000X
TXBP10056554208000000X
OK7546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK201049770AMedicaid