Provider Demographics
NPI:1780688770
Name:BHAGAT, PRAGNA R (MD)
Entity Type:Individual
Prefix:
First Name:PRAGNA
Middle Name:R
Last Name:BHAGAT
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:P.O .BOX 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0000
Mailing Address - Country:US
Mailing Address - Phone:610-789-8070
Mailing Address - Fax:610-789-9937
Practice Address - Street 1:250 SOUTH 21ST STREET
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-250-4075
Practice Address - Fax:610-789-9937
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030825E207L00000X
NJ25MA07732900207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01012730Medicaid
11920943OtherCAQH
042431Medicare PIN
PA01012730Medicaid