Basic Information
| Provider Information | |||||||||
| NPI: | 1417107293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BABY | ||||||||
| FirstName: | VARUGHESE | ||||||||
| MiddleName: | MAX | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3430 HIDDEN CREEK DR | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774791651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167493845 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4314 YOAKUM BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770065818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138500049 | ||||||||
| FaxNumber: | 7138500036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 07/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 525591 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LP0808X | 781646 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 215863603 | 05 | TX | MEDICAID | 215863602 | 05 | TX | MEDICAID | 215863605 | 05 | TX | MEDICAID | P00967678 | 01 | TX | RAIL ROAD MCR DALLAS | OTHER | 859N32 | 01 | TX | BCBS TX | OTHER | 215863604 | 05 | TX | MEDICAID | P00889009 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 834N18 | 01 | TX | BCBS TX | OTHER | 215863601 | 05 | TX | MEDICAID | 847N28 | 01 | TX | BCBS TX | OTHER |