Provider Demographics
NPI:1083670178
Name:TRIVEDI, BHARGAV RAMESHCHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:BHARGAV
Middle Name:RAMESHCHANDRA
Last Name:TRIVEDI
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 1:11797 SOUTH FWY
Mailing Address - Street 2:SUITE 326
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7026
Mailing Address - Country:US
Mailing Address - Phone:817-293-9008
Mailing Address - Fax:817-293-9044
Practice Address - Street 1:11797 SOUTH FWY
Practice Address - Street 2:SUITE 326
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7026
Practice Address - Country:US
Practice Address - Phone:817-293-9008
Practice Address - Fax:817-293-9044
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH25849Medicare UPIN