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General NPI Number Information
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NPI Number | 1043849078
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Entity Type | Individual
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Provider Name | SIDDHARTH BHARGAVA MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 555 N 13TH AVE
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City | UPLAND
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State | CA
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Zip | 91786-4904
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Country | US
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Telephone | 800-345-8979
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Fax | 909-949-3967
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-362-3937
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Fax | 314-362-3725
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0009X
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Taxonomy Name | Glaucoma Specialist (Ophthalmology) Physician
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License Number | 2024011050
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A202244
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License Number State | CA
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