Provider Demographics
NPI:1043208663
Name:AGARWALA, KRISHNA PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:PRASAD
Last Name:AGARWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2104 FRONT ST STE B
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3259
Mailing Address - Country:US
Mailing Address - Phone:330-923-3502
Mailing Address - Fax:330-923-3507
Practice Address - Street 1:2104 FRONT ST STE B
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3259
Practice Address - Country:US
Practice Address - Phone:330-923-3502
Practice Address - Fax:330-923-3507
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036016A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A14806Medicare UPIN
OHH157380Medicare PIN