Healthcare Provider Details

I. General information

NPI: 1679788657
Provider Name (Legal Business Name): ALEX VARGHESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 QUINCY AVE
BROCKTON MA
02302-2803
US

IV. Provider business mailing address

21 GEORGE ST FL 1
LOWELL MA
01852-2228
US

V. Phone/Fax

Practice location:
  • Phone: 508-894-0575
  • Fax: 508-941-6446
Mailing address:
  • Phone: 314-983-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number235898
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number235898
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: