1386603421 NPI number — PANKAJ BHARGAVA MD

Table of content: PANKAJ BHARGAVA MD (NPI 1386603421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386603421 NPI number — PANKAJ BHARGAVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHARGAVA
Provider First Name:
PANKAJ
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386603421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 BINNEY ST
Provider Second Line Business Mailing Address:
D1220 DANA-FARBER CANCER INSTITUTE
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-632-6184
Provider Business Mailing Address Fax Number:
617-632-5370

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 BINNEY ST
Provider Second Line Business Practice Location Address:
DANA-FARBER CANCER INSTITUTE
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-632-6184
Provider Business Practice Location Address Fax Number:
617-632-5370
Provider Enumeration Date:
03/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  207770 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4123875 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA22040 . This is a "HPHC DFCI ONLY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 207770 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3717077 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A31992 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0124389 . This is a "MASSHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: J23168 . This is a "BCBS INDEMITY BC ELECT HM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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