1548600547 NPI number — MRS. MARY LAUREL VARGHESE NP-C

Table of content: MRS. MARY LAUREL VARGHESE NP-C (NPI 1548600547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548600547 NPI number — MRS. MARY LAUREL VARGHESE NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGHESE
Provider First Name:
MARY
Provider Middle Name:
LAUREL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548600547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743294
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-834-7834
Provider Business Mailing Address Fax Number:
864-834-7477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 S POINSETT HWY
Provider Second Line Business Practice Location Address:
TRAVELERS REST INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
TRAVELERS REST
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29690-1822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-834-7834
Provider Business Practice Location Address Fax Number:
864-834-7477
Provider Enumeration Date:
07/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  20185 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003140025A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: NP3996 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com