Healthcare Provider Details

I. General information

NPI: 1538139266
Provider Name (Legal Business Name): ROY VARGHESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 KATE IRELAND DR
HYDEN KY
41749
US

IV. Provider business mailing address

130 KATE IRELAND DR
HYDEN KY
41749
US

V. Phone/Fax

Practice location:
  • Phone: 606-672-2901
  • Fax: 606-672-3626
Mailing address:
  • Phone: 606-672-2901
  • Fax: 606-672-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18866
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18866
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: