Healthcare Provider Details

I. General information

NPI: 1952074262
Provider Name (Legal Business Name): ASHWIN KODAGNUR BHARADWAJ MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MADISON AVE
MEMPHIS TN
38103-3409
US

IV. Provider business mailing address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-6258
  • Fax: 901-545-7177
Mailing address:
  • Phone: 732-745-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number76939
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: