Healthcare Provider Details

I. General information

NPI: 1124027776
Provider Name (Legal Business Name): MOHAMMAD ALI VARGHAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2005
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 LAKE AVE
ASHTABULA OH
44004-4954
US

IV. Provider business mailing address

2420 LAKE AVE
ASHTABULA OH
44004-4954
US

V. Phone/Fax

Practice location:
  • Phone: 440-994-7600
  • Fax: 440-994-7603
Mailing address:
  • Phone: 440-994-7600
  • Fax: 440-994-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35-053339
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: