Healthcare Provider Details

I. General information

NPI: 1073715702
Provider Name (Legal Business Name): BETTY RACHEL VARGHESE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PROGRESS POINT CT
O FALLON MO
63368-2208
US

IV. Provider business mailing address

2 PROGRESS POINT CT
O FALLON MO
63368-2208
US

V. Phone/Fax

Practice location:
  • Phone: 636-344-1151
  • Fax: 636-344-1176
Mailing address:
  • Phone: 636-344-1151
  • Fax: 636-344-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2005021815
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2005021815
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: