Provider Demographics
NPI:1285621128
Name:BHARDWAJA, POOJA (MD)
Entity type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:BHARDWAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 E SUPERSTITION SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4001
Mailing Address - Country:US
Mailing Address - Phone:480-641-4000
Mailing Address - Fax:480-641-4069
Practice Address - Street 1:4530 E MUIRWOOD DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7639
Practice Address - Country:US
Practice Address - Phone:480-961-2303
Practice Address - Fax:480-961-0419
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5538418OtherCCN HEALTH NETWORK
AZ7649574OtherAETNA
AZAZ0761270OtherBLUE CROSS BLUE SHIELD AZ
AZ825432Medicaid
AZ825432001OtherMERCYCARE
AZ2232666OtherFIRST HEALTH
AZ825432Medicaid
AZP00179885Medicare PIN
Z83784Medicare PIN