Provider Demographics
NPI:1891914206
Name:GARG, NITIN (MBBS)
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:
Last Name:GARG
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10825 W MCDOWELL RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392
Mailing Address - Country:US
Mailing Address - Phone:602-641-9486
Mailing Address - Fax:480-500-8430
Practice Address - Street 1:10825 W MCDOWELL RD
Practice Address - Street 2:SUITE 310
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392
Practice Address - Country:US
Practice Address - Phone:602-641-9486
Practice Address - Fax:480-500-8430
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4967208600000X
SC340142086S0129X
MN524432086S0129X
NE300392086S0129X
390200000X
AZ594132086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC340143Medicaid
MNENROLLEDMedicaid