Healthcare Provider Details

I. General information

NPI: 1447694252
Provider Name (Legal Business Name): BENOY VARGHESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 W MEMORIAL RD
OKLAHOMA CITY OK
73120-8358
US

IV. Provider business mailing address

PO BOX 268919
OKLAHOMA CITY OK
73126-8919
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-3800
  • Fax:
Mailing address:
  • Phone: 405-608-3800
  • Fax: 405-608-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number83755
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29844
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number83755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: