Provider Demographics
NPI:1144071499
Name:VARGHESE, JOHN KOYICKAL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KOYICKAL
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BENNY
Other - Middle Name:KOYICKAL
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22 S GREENE ST RM S11C
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1590
Mailing Address - Country:US
Mailing Address - Phone:410-328-6120
Mailing Address - Fax:410-328-5531
Practice Address - Street 1:22 S GREENE ST RM S11C
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1590
Practice Address - Country:US
Practice Address - Phone:410-328-6120
Practice Address - Fax:410-328-5531
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program