Provider Demographics
NPI:1689778839
Name:BHOGAL, MADHU R (MD)
Entity Type:Individual
Prefix:MRS
First Name:MADHU
Middle Name:R
Last Name:BHOGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3801 SAN DIMAS
Mailing Address - Street 2:B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-631-2229
Mailing Address - Fax:661-631-2638
Practice Address - Street 1:3801 SAN DIMAS
Practice Address - Street 2:B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-631-2229
Practice Address - Fax:661-631-2638
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA405732080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A405730Medicare ID - Type Unspecified
B16859Medicare UPIN