Provider Demographics
NPI:1053314187
Name:BHARGAVA, MANU (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:MANU
Middle Name:
Last Name:BHARGAVA
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 AUDUBON OAKS
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2798
Mailing Address - Country:US
Mailing Address - Phone:318-767-2276
Mailing Address - Fax:
Practice Address - Street 1:101 MEDICAL PARK BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-561-0252
Practice Address - Fax:318-561-2454
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13747R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1435775Medicaid