Healthcare Provider Details

I. General information

NPI: 1326259623
Provider Name (Legal Business Name): JOSHUA MATTHEW VARGHISE MAMMEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986880 NEBRASKA MEDICAL CENTER
OMAHA NE
68198-6880
US

IV. Provider business mailing address

986880 NEBRASKA MEDICAL CENTER
OMAHA NE
68198-6880
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-7298
  • Fax:
Mailing address:
  • Phone: 402-559-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberM6740
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number33153
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: