Healthcare Provider Details

I. General information

NPI: 1275624819
Provider Name (Legal Business Name): PUNEET BHARGAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE UW PHYSICIANS
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY MAIL BOX 358280, S-114/RADIOLOGY,
SEATTLE WA
98108-1597
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5307
  • Fax:
Mailing address:
  • Phone: 206-764-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD60003758
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: