Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01077384A | IN |
Y | 111NI0900X | Internist | 01077384A | IN |
N | 207R00000X | Internist | 25429 | WV |
N | 111NI0900X | Internist | 25429 | WV |
N | 207R00000X | Internist | 4301096387 | MI |
N | 111NI0900X | Internist | 4301096387 | MI |
NPI | 1003136367 |
---|---|
Provider Name | Justin Varghese |
First Address | Richmond, IN 47374 |
Second Address | Richmond, IN 47374-1157 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2010 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300032913 | (05) | IN |