Provider Demographics
NPI:1114980968
Name:BHARGAVA, ALOK (MD)
Entity Type:Individual
Prefix:
First Name:ALOK
Middle Name:
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 1:134 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2507
Mailing Address - Country:US
Mailing Address - Phone:203-755-3279
Mailing Address - Fax:203-755-3057
Practice Address - Street 1:134 GRANDVIEW AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2507
Practice Address - Country:US
Practice Address - Phone:203-755-3279
Practice Address - Fax:203-755-3057
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0308472084N0402X, 208000000X, 2080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010030847CT01OtherBLUE CROSS & BLUE SHIELD
CT001308479Medicaid
CT030847OtherCONNECTICARE
CTE57916Medicare UPIN
CT001308479Medicaid