Healthcare Provider Details

I. General information

NPI: 1508541814
Provider Name (Legal Business Name): NEHA ANN VARGHESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date: 01/22/2024
Reactivation Date: 02/06/2024

III. Provider practice location address

27B WOODLANDS DR
WAYMART PA
18472-9366
US

IV. Provider business mailing address

601 PARK ST
HONESDALE PA
18431-1445
US

V. Phone/Fax

Practice location:
  • Phone: 570-488-9550
  • Fax: 570-488-9553
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD493249
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: