Provider Demographics
NPI:1508861741
Name:BHARGAVA, MUKESH (M D)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:
Last Name:BHARGAVA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25A JUNE ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-2642
Mailing Address - Country:US
Mailing Address - Phone:207-324-5968
Mailing Address - Fax:207-490-1758
Practice Address - Street 1:25A JUNE ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2642
Practice Address - Country:US
Practice Address - Phone:207-324-5968
Practice Address - Fax:207-490-1758
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134860000Medicaid
ME134860000Medicaid
MEG32427Medicare UPIN