Healthcare Provider Details

I. General information

NPI: 1568450534
Provider Name (Legal Business Name): PRAMOD ANAND BHARGAVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46550 HILLS AND DALES RD NW
CANTON OH
44708
US

IV. Provider business mailing address

46550 HILLS AND DALES RD NW
CANTON OH
44708
US

V. Phone/Fax

Practice location:
  • Phone: 330-649-9400
  • Fax: 330-649-8059
Mailing address:
  • Phone: 330-649-9400
  • Fax: 330-649-8059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35085774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: