Provider Demographics
NPI:1700874153
Name:DWIVEDI, GARGI M (MD)
Entity Type:Individual
Prefix:
First Name:GARGI
Middle Name:M
Last Name:DWIVEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1510
Practice Address - Country:US
Practice Address - Phone:602-992-1900
Practice Address - Fax:602-485-7450
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ33472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7627675OtherAETNA
AZAZ0774830OtherBLUE CROSS BLUE SHEILD
AZ7627675OtherAETNA
AZAZ0774830OtherBLUE CROSS BLUE SHEILD