Healthcare Provider Details

I. General information

NPI: 1942477559
Provider Name (Legal Business Name): ROSEMARY JOSEPH VERGHESE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 SAINT PATRICKS DR SUITE 201
WALDORF MD
20603-5529
US

IV. Provider business mailing address

777 7TH ST NW APT 824
WASHINGTON DC
20001-5709
US

V. Phone/Fax

Practice location:
  • Phone: 301-396-3401
  • Fax:
Mailing address:
  • Phone: 703-899-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0069811
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0069811
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: