Sharwan K Bagla, MD

Primary specialty

Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X

License

127799 Issued in NY

Practice address

99 Main St
Kings Park, NY 11754-2706

Phone

(631) 269-5550

Fax

(631) 269-6304

NPI assigned

Oct 28, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257724800000",
    "number": "1043201189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 MAIN ST",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "117542706",
            "telephone_number": "631-269-5550",
            "fax_number": "631-269-6304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 MAIN ST",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "117542706",
            "telephone_number": "631-269-5550",
            "fax_number": "631-269-6304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGLA",
        "first_name": "SHARWAN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2009-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "NY",
            "license": "127799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "418222",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Angelopoulos, PHARM.D
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• Mark Vernon Applewhite, NY STATE LCSW-R
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• Marie Virgine Aristilde, PSYD
• Jessica Ball, DPT
• Kristin Nastasia Bamonte, L.M.T.
• Megan Barco
• Ryan Barkey, RDA-A, FASMLAP
• Joann Barrett, C.A.S.A.C.

• All providers in Kings Park, NY
• Adolescent Medicine (Internal Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.