Healthcare Provider Details

I. General information

NPI: 1154311496
Provider Name (Legal Business Name): KOSHY K VARGHESE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SHOAL CREEK BLVD STE 130W
AUSTIN TX
78757-1040
US

IV. Provider business mailing address

645 COUNTY ROAD 262
GEORGETOWN TX
78628-1970
US

V. Phone/Fax

Practice location:
  • Phone: 512-407-8880
  • Fax:
Mailing address:
  • Phone: 512-508-2711
  • Fax: 512-869-8648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK6732
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK6732
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberK6732
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: