Healthcare Provider Details

I. General information

NPI: 1356760524
Provider Name (Legal Business Name): BETHESDA MEDICAL CLINIC INFUSION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
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 3400B
MARRERO LA
70072-3044
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 TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD203694
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD203694
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD203694
License Number StateLA

VIII. Authorized Official

Name: DR. SHIBU VARUGHESE
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 504-265-8304