MEDICARE: VINNY M VARGHESE MD PA

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	207R00000X	Internal Medicine Physician	ME 85292	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17184Y	OTHER	FL	MEDICARE INDIVIDUAL PTAN
2	AH745	OTHER	FL	MEDICARE GROUP PTAN

General Provider Information

NPI Number	:	1811179872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINNY M VARGHESE MD PA

Provider Business Mailing Address
First Line	:	2720 REBECCA LN STE 2
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8351
Country	:	US
Telephone Number	:	386-228-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 REBECCA LN STE 2
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8351
Country	:	US
Telephone Number	:	386-228-1234
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. CYNTHIA MANJALY
Credential	:
Telephone Number	:	386-228-1234

Provider Enumeration Date	:	12/02/2007
Last Update Date	:	04/15/2008

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Directions to “VINNY M VARGHESE MD PA ” Practice Location

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