Provider Demographics
NPI:1881821825
Name:GANNAVARAPU, BHARGAVA (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARGAVA
Middle Name:
Last Name:GANNAVARAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1586
Mailing Address - Country:US
Mailing Address - Phone:972-639-6400
Mailing Address - Fax:408-471-2200
Practice Address - Street 1:200 JOSE FIGUERES AVE STE 170
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1586
Practice Address - Country:US
Practice Address - Phone:408-471-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN/A207R00000X
IL036136569207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine