Healthcare Provider Details

I. General information

NPI: 1053314187
Provider Name (Legal Business Name): MANU BHARGAVA M.D., F.A.A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEDICAL PARK BLVD. SUITE A
PINEVILLE LA
71360
US

IV. Provider business mailing address

6321 AUDUBON OAKS
ALEXANDRIA LA
71301-2798
US

V. Phone/Fax

Practice location:
  • Phone: 318-561-0252
  • Fax: 318-561-2454
Mailing address:
  • Phone: 318-767-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13747R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: