Healthcare Provider Details

I. General information

NPI: 1992005854
Provider Name (Legal Business Name): BHARGAVI TANGIRALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 THOMAS MORE PKWY STE 202
FT MITCHELL KY
41017-5103
US

IV. Provider business mailing address

830 THOMAS MORE PKWY STE 404
FT MITCHELL KY
41017-5102
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-6281
  • Fax: 330-729-9297
Mailing address:
  • Phone: 859-341-6281
  • Fax: 330-729-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35121812
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: