Provider Demographics
NPI:1427010404
Name:BHAGIA, PRITI
Entity type:Individual
Prefix:
First Name:PRITI
Middle Name:
Last Name:BHAGIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 SPRINGBANK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3025 SPRINGBANK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3362
Practice Address - Country:US
Practice Address - Phone:704-446-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-00012207R00000X
NC200400012207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902902Medicaid
NC1352TOtherBCBSNC
SCN00013Medicaid
NC1427010404Medicaid
NCH20289Medicare UPIN
NC1352TOtherBCBSNC
NC2021641CMedicare PIN
NC5902902Medicaid
NC1427010404Medicaid