Provider Demographics
NPI:1073595864
Name:BHARGAVA, ASHOK NATH (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:NATH
Last Name:BHARGAVA
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 1:19 SOCRATES WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890
Mailing Address - Country:US
Mailing Address - Phone:781-729-6833
Mailing Address - Fax:781-369-1155
Practice Address - Street 1:49 ROBINWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-522-4400
Practice Address - Fax:617-390-1584
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0164755Medicaid
MAJ10981OtherMEDICARE
MA0164755Medicaid
MAJ10981OtherMEDICARE