Healthcare Provider Details

I. General information

NPI: 1124516497
Provider Name (Legal Business Name): MRS. SUMA VARGHESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 N CHARLES ST
TOWSON MD
21204-6808
US

IV. Provider business mailing address

9240 HINES ESTATES DR
PARKVILLE MD
21234-1365
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2000
  • Fax:
Mailing address:
  • Phone: 412-716-3225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR173280
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: