Healthcare Provider Details

I. General information

NPI: 1730211673
Provider Name (Legal Business Name): AMIT BHARGAVA, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9199 REISTERSTOWN RD STE 107B
OWINGS MILLS MD
21117-4520
US

IV. Provider business mailing address

9199 REISTERSTOWN RD STE 107B
OWINGS MILLS MD
21117-4520
US

V. Phone/Fax

Practice location:
  • Phone: 410-581-2969
  • Fax: 410-998-3995
Mailing address:
  • Phone: 410-581-2969
  • Fax: 410-998-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIT BHARGAVA
Title or Position: OWNER
Credential: MD
Phone: 410-581-2969