Provider Demographics
NPI:1902917891
Name:VERGHESE, PRIYA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:VERGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STREET SE, MMC 491
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA DEPARTMENT OF PEDIATRICS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-2765
Mailing Address - Fax:612-626-2791
Practice Address - Street 1:420 DELAWARE STREET SE, MMC 491
Practice Address - Street 2:UNIVERSITY OF MINNESOTA DEPARTMENT OF PEDIATRICS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-2765
Practice Address - Fax:612-626-2791
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAML200083982080P0210X
MN52398208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology