Provider Demographics
NPI:1538328620
Name:MANDIPALLE, BHARGAVI (MD)
Entity Type:Individual
Prefix:MS
First Name:BHARGAVI
Middle Name:
Last Name:MANDIPALLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47703-0359
Mailing Address - Country:US
Mailing Address - Phone:812-485-1220
Mailing Address - Fax:812-485-1200
Practice Address - Street 1:1116 MILLIS AVE
Practice Address - Street 2:STE 101
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-2292
Practice Address - Country:US
Practice Address - Phone:812-897-7175
Practice Address - Fax:812-897-7125
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01070721A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine