Individual
MARY VERGHESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-3636
(317) 948-5844
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01059018A
IN
208000000X
Pediatrics Physician
Primary
01059018A
IN
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
01059018
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000741646
ANTHEM PIN
IN
05
—
200481970
—
IN
Enumeration date
07/10/2006
Last updated
11/21/2024
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