Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01059018A | IN |
N | 2080P0204X | Pediatric Emergency Doctor | 01059018 | IN |
NPI | 1265466908 |
---|---|
Provider Name | Mary Verghese |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 06/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000741646 | ANTHEM PIN (01) | IN |
200481970 | (05) | IN |
I16608 | (02) |