MEDICARE: MRS. SUSHA VERGHESE AU.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
1	231H00000X	Audiologist	12086371	VA

General Provider Information

NPI Number	:	1760615959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSHA VERGHESE AU.D

Provider Business Mailing Address
First Line	:	10200 THREE CHOPT RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-2012
Country	:	US
Telephone Number	:	804-288-3277
Fax Number	:	804-282-1043

Provider Business Practice Location Address
First Line	:	10200 THREE CHOPT RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-2012
Country	:	US
Telephone Number	:	804-288-3277
Fax Number	:	804-282-1043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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