Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | K6732 | TX |
N | 207R00000X | Internist | K6732 | TX |
N | 111NI0900X | Internist | K6732 | TX |
Y | 207RG0300X | Geriatric Medicine | K6732 | TX |
NPI | 1154311496 |
---|---|
Provider Name | Dr. Koshy K Varghese |
First Address | Georgetown, TX 78628-1970 |
Second Address | Austin, TX 78757-1040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 25/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G88679 | (02) | TX |