Provider Demographics
NPI:1144215138
Name:AGARWAL, SUDHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHIR
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 1:2410 NORTHSIDE DR
Mailing Address - Street 2:STE A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2236
Mailing Address - Country:US
Mailing Address - Phone:727-499-0351
Mailing Address - Fax:727-781-3312
Practice Address - Street 1:3543 LITTLE RD STE A
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1814
Practice Address - Country:US
Practice Address - Phone:727-848-6400
Practice Address - Fax:727-848-6200
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64377207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
01915OtherUNIVERSAL
213431OtherAVMED
FL373248700Medicaid
060063819OtherRRW MCR
FL23069OtherBCBS
P00638011OtherRAILROAD MEDICARE
060063819OtherRRW MCR
FL373248700Medicaid
01915OtherUNIVERSAL