Provider Demographics
NPI:1346475506
Name:VARUGHESE, SHIBU (MD)
Entity type:Individual
Prefix:DR
First Name:SHIBU
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 BARATARIA BLVD STE 3400
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3083
Mailing Address - Country:US
Mailing Address - Phone:504-265-8304
Mailing Address - Fax:504-309-4193
Practice Address - Street 1:1151 BARATARIA BLVD STE 3400
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3083
Practice Address - Country:US
Practice Address - Phone:504-265-8304
Practice Address - Fax:504-309-4193
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31922183500000X
FLME171498207RG0300X
LAMD203694207RG0300X, 207RH0002X, 207RH0003X
LAMD.203694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No183500000XPharmacy Service ProvidersPharmacist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2107780Medicaid
FLCQ321ZMedicare UPIN
LA2107780Medicaid