Chronic exposure to groundwater containing elevated concentrations of geogenic contaminants such as arsenic (As) and uranium (U) can lead to detrimental health impacts. In this study, we have undertaken a groundwater survey of representative sites across all districts of the State of Bihar, in the Middle Gangetic Plain of north-eastern India. The aim is to characterize the inorganic major and trace element aqueous geochemistry in groundwater sources widely used for drinking in Bihar, with a particular focus on the spatial distribution and associated geochemical controls on groundwater As and U. Concentrations of As and U are highly heterogeneous across Bihar, exceeding (provisional) guideline values in ~16% and 7% of samples (n = 273), respectively. The strongly inverse correlation between As and U is consistent with the contrasting redox controls on As and U mobility. High As is associated with Fe, Mn, lower Eh and is depth-dependent; in contrast, high U is associated with HCO
- and higher Eh. The improved understanding of the distribution and geochemical controls on As and U in Bihar has important implications on remediation priorities and selection, and may contribute to informing further monitoring and/or representative characterization efforts in Bihar and elsewhere in India.