Provider Demographics
NPI:1043265754
Name:AGARWAL, DEEPAK (MD)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1243
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01202-1243
Mailing Address - Country:US
Mailing Address - Phone:413-447-2453
Mailing Address - Fax:413-447-2441
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4132
Practice Address - Country:US
Practice Address - Phone:413-447-2453
Practice Address - Fax:413-447-2441
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0452352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2002540Medicaid
NY02410740Medicaid
A78705Medicare UPIN
MAA35030Medicare ID - Type Unspecified