Provider Demographics
NPI:1336114115
Name:HARGROVE, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:HARGROVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 MERLIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1606
Mailing Address - Country:US
Mailing Address - Phone:914-490-8568
Mailing Address - Fax:718-933-8208
Practice Address - Street 1:3130 GRAND CONCOURSE
Practice Address - Street 2:SUITE B8
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-365-5662
Practice Address - Fax:718-933-8208
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1883492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01623812Medicaid
NY01623812Medicaid
NY34M811Medicare PIN