Healthcare Provider Details

I. General information

NPI: 1346475506
Provider Name (Legal Business Name): SHIBU VARUGHESE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BARATARIA BLVD STE 3400
MARRERO LA
70072-3083
US

IV. Provider business mailing address

1151 BARATARIA BLVD STE 3400
MARRERO LA
70072-3083
US

V. Phone/Fax

Practice location:
  • Phone: 504-265-8304
  • Fax: 504-309-4193
Mailing address:
  • Phone: 504-265-8304
  • Fax: 504-309-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS31922
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.203694
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME171498
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD203694
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD203694
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD203694
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: