Provider Demographics
NPI:1477526044
Name:BHARADWAJ, RAVINDRA MOHAN (MD)
Entity type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:MOHAN
Last Name:BHARADWAJ
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:PO BOX 845347 PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7298
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5939 HARRY HINES BLVD 8TH FLOOR STE HQ08.124
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-1786
Practice Address - Country:US
Practice Address - Phone:214-645-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43992207R00000X, 207RG0300X
IN01056005A207R00000X
TX44727207RG0300X
TXQ2739207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303346601Medicaid
OK20447390 AMedicaid
IN01056005AOtherSTATE LICENSURE
TX303346602Medicaid
IN200425170AMedicaid
NM75152835Medicaid
NM75152835Medicaid
OK20447390 AMedicaid
TX303346601Medicaid
NM75152835Medicaid