1295712602 NPI number — RAJESH AGRAWAL MD

Table of content: RAJESH AGRAWAL MD (NPI 1295712602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295712602 NPI number — RAJESH AGRAWAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGRAWAL
Provider First Name:
RAJESH
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:
1295712602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6223 66TH STREET NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINELLAS PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33781-5025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-528-4900
Provider Business Mailing Address Fax Number:
727-528-8628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6223 66TH STREET NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINELLAS PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33781-5025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-528-4900
Provider Business Practice Location Address Fax Number:
727-528-8628
Provider Enumeration Date:
12/28/2005

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: 207RP1001X , with the licence number:  ME68290 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1467464990 . This is a "GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261164300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6000/211534 . This is a "AVMED PROVIDER NUMBERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110200401 . This is a "MEDICARE RAILROAD INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 250206200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH2504 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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