Basic Information
| Provider Information | |||||||||
| NPI: | 1386846673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARGHESE | ||||||||
| FirstName: | SIMMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 11 O CLOCK RD | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068832548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146737755 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 34 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068503894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038522000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 71152 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.