Healthcare Provider Details

I. General information

NPI: 1720570716
Provider Name (Legal Business Name): SAM VARGHESE THOMAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD STE 2E70
NEWARK DE
19718-2200
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD STE 2E70
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-3475
  • Fax: 302-733-6082
Mailing address:
  • Phone: 302-733-3475
  • Fax: 302-733-6082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC2-0024482
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC2-0024482
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MB11327000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MB11327000
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB11327000
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC2-0024482
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: