Provider Demographics
NPI:1982859351
Name:THANGALI VARADARAJU, BHARGAV (MD)
Entity Type:Individual
Prefix:
First Name:BHARGAV
Middle Name:
Last Name:THANGALI VARADARAJU
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 3126
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7711
Mailing Address - Country:US
Mailing Address - Phone:479-601-2314
Mailing Address - Fax:888-664-5545
Practice Address - Street 1:153 E MONTE PAINTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4002
Practice Address - Country:US
Practice Address - Phone:479-601-2314
Practice Address - Fax:888-664-5545
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6225207R00000X
PAMT187633390200000X
ARE 6225208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178569001Medicaid
OK200260650AMedicaid
AR5H917Medicare PIN