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NPI Code Detail

MEDICARE: DR. JILU J. VARGHESE M.D

MEDICARE: DR. JILU J. VARGHESE M.D
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
1207Q00000XFamily Medicine Physician25MA08998500NJ
2207Q00000XFamily Medicine PhysicianR0972TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386875698
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JILU J. VARGHESE M.D
Provider Business Mailing Address
First Line : 2255 E MOSSY OAKS RD STE 500
Second Line :
City : SPRING
State : TX
Zip : 77389-1813
Country : US
Telephone Number : 281-440-5300
Fax Number : 832-232-5591
Provider Business Practice Location Address
First Line : 2255 E MOSSY OAKS RD STE 500
Second Line :
City : SPRING
State : TX
Zip : 77389-1813
Country : US
Telephone Number : 281-440-5300
Fax Number : 832-232-5591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2009
Last Update Date : 07/21/2022

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