Provider Demographics
NPI:1083693352
Name:AGARWAL, AMISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMISHA
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
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 11398
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1398
Mailing Address - Country:US
Mailing Address - Phone:877-448-8675
Mailing Address - Fax:772-621-3181
Practice Address - Street 1:4725 N. FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:954-267-6650
Practice Address - Fax:954-351-7874
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072819L2085R0202X
FLME968442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001972676Medicaid
PA073049Medicare ID - Type Unspecified
FLAA775YMedicare PIN
FLAA775ZMedicare PIN
PA001972676Medicaid