MEDICARE: GEORGE VARGHESE MD & ASSOC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114910601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE VARGHESE MD & ASSOC INC

Provider Business Mailing Address
First Line	:	247 S BURNETT RD
Second Line	:	STE 100
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-2639
Country	:	US
Telephone Number	:	937-322-7364
Fax Number	:	937-322-4047

Provider Business Practice Location Address
First Line	:	247 S BURNETT RD
Second Line	:	STE 100
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-2639
Country	:	US
Telephone Number	:	937-322-7364
Fax Number	:	937-322-4047

Authorized Official
Title or Position	:	PRESIDENT OF CORPORATION
Name	:	GEORGE VARGHESE
Credential	:	MD
Telephone Number	:	937-322-7364

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	08/22/2020

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