Provider Demographics
NPI:1073797460
Name:AGBAHIWE, HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:AGBAHIWE
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 1:3040 WILLIAMS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:703-934-4450
Mailing Address - Fax:703-934-5533
Practice Address - Street 1:8613 LEE HWY STE 100N
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2172
Practice Address - Country:US
Practice Address - Phone:713-508-4005
Practice Address - Fax:703-934-5533
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012576472085R0001X, 2085R0001X
DCMD0417922085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073797460Medicaid
DC299867ZAN3Medicare PIN