Provider Demographics
NPI:1336336064
Name:PULIPATI, BHARGAVA CHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:BHARGAVA
Middle Name:CHANDRA
Last Name:PULIPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:475 E MAIN ST
Mailing Address - Street 2:STE 205
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3121
Mailing Address - Country:US
Mailing Address - Phone:631-654-2386
Mailing Address - Fax:631-447-3852
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-654-2386
Practice Address - Fax:631-447-3852
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2016-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2502711207RC0000X
NY250271390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease