Provider Demographics
NPI:1336381193
Name:BAGRODIA, MONA AMBIKA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:AMBIKA
Last Name:BAGRODIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:AMBIKA
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:757 E US HIGHWAY 80 STE 200
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8741
Mailing Address - Country:US
Mailing Address - Phone:972-646-3346
Mailing Address - Fax:
Practice Address - Street 1:757 E US HIGHWAY 80 STE 200
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8741
Practice Address - Country:US
Practice Address - Phone:972-646-3346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics