Healthcare Provider Details

I. General information

NPI: 1285072413
Provider Name (Legal Business Name): ALVIN VARGHESE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 OAKDALE AVE N
ROBBINSDALE MN
55422-2926
US

IV. Provider business mailing address

600 MCCLELLAN ST 2 WEST
SCHENECTADY NY
12304-1009
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-5200
  • Fax: 763-581-6401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65752
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number283243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: