Provider Demographics
NPI:1184882540
Name:MUKESH BHARGAVA, M. D. LLC
Entity type:Organization
Organization Name:MUKESH BHARGAVA, M. D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARGAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-324-5968
Mailing Address - Street 1:25A JUNE ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-2642
Mailing Address - Country:US
Mailing Address - Phone:207-324-5968
Mailing Address - Fax:207-490-1758
Practice Address - Street 1:25A JUNE ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2642
Practice Address - Country:US
Practice Address - Phone:207-324-5968
Practice Address - Fax:207-490-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-01
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG32427Medicare UPIN