MEDICARE: VINO J VERGHESE MD

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	207RG0100X	Gastroenterology Physician	A76713	CA

General Provider Information

NPI Number	:	1912906272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINO J VERGHESE MD

Provider Business Mailing Address
First Line	:	325 DISTEL CIR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1408
Country	:	US
Telephone Number	:	650-652-8480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 TROUSDALE DR
Second Line	:	3RD FLOOR
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4506
Country	:	US
Telephone Number	:	650-652-8480
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/22/2020

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