Provider Demographics
NPI:1376848358
Name:KOLA, BHARGAVI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARGAVI
Middle Name:
Last Name:KOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W 5TH STREET
Mailing Address - Street 2:TEXAS TECH UNIVERSITY OF HEALTH SCIENCE
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4206
Mailing Address - Country:US
Mailing Address - Phone:432-335-1500
Mailing Address - Fax:432-335-1537
Practice Address - Street 1:701 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4206
Practice Address - Country:US
Practice Address - Phone:432-335-1500
Practice Address - Fax:432-335-1537
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08745400208000000X
TXP2281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics