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General NPI Number Information
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NPI Number | 1285683573
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Entity Type | Individual
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Provider Name | MYRA THERESA VARGAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 1261 ROUTE 38 SUITE A
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City | HAINESPORT
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State | NJ
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Zip | 08036-2702
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Country | US
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Telephone | 856-222-1975
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Fax | 856-222-0721
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Provider Business Mailing Address
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Address Line | 1261 ROUTE 38 SUITE A
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City | HAINESPORT
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State | NJ
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Zip | 08036-2702
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Country | US
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Telephone | 856-222-1975
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Fax | 856-222-0721
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MA 62484
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License Number State | NJ
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