Basic Information
| Provider Information | |||||||||
| NPI: | 1831470764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VERGHESE & LING, MD PA | ||||||||
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| OtherOrganizationName: | MID ATLANTIC SKIN SURGERY INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 173 SAINT PATRICKS DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206035531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013963401 | ||||||||
| FaxNumber: | 3013963404 | ||||||||
| Practice Location | |||||||||
| Address1: | 26840 POINT LOOKOUT RD | ||||||||
| Address2: | SHANTI MEDICAL CENTER | ||||||||
| City: | LEONARDTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206501409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014758091 | ||||||||
| FaxNumber: | 3014756712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2011 | ||||||||
| LastUpdateDate: | 04/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | VERGHESE | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3013963401 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207N00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.