Healthcare Provider Details

I. General information

NPI: 1720142110
Provider Name (Legal Business Name): HEMANT K BHARGAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S SUITE 404
ST AUGUSTINE FL
32080-3108
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S SUITE 404
ST AUGUSTINE FL
32080-3108
US

V. Phone/Fax

Practice location:
  • Phone: 904-461-1560
  • Fax: 904-461-4304
Mailing address:
  • Phone: 904-461-1560
  • Fax: 904-461-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME67841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: