Provider Demographics
NPI:1144424953
Name:AGARWAL, ANUBHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUBHA
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANUBHA
Other - Middle Name:A
Other - Last Name:JAIRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8710 TALLY HO LN
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4541
Mailing Address - Country:US
Mailing Address - Phone:561-818-2612
Mailing Address - Fax:
Practice Address - Street 1:8710 TALLY HO LN
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4541
Practice Address - Country:US
Practice Address - Phone:561-818-2612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000582000Medicaid
AP619ZMedicare PIN