MEDICARE: DR. MUKESH BHARGAVA M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	014252	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508861741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUKESH BHARGAVA M. D.

Provider Business Mailing Address
First Line	:	25A JUNE ST
Second Line	:	SUITE 111
City	:	SANFORD
State	:	ME
Zip	:	04073-2642
Country	:	US
Telephone Number	:	207-324-5968
Fax Number	:	207-490-1758

Provider Business Practice Location Address
First Line	:	25A JUNE ST
Second Line	:	SUITE 111
City	:	SANFORD
State	:	ME
Zip	:	04073-2642
Country	:	US
Telephone Number	:	207-324-5968
Fax Number	:	207-490-1758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	09/18/2008

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