Provider Demographics
NPI:1225136484
Name:AGRAWAL, ASHISH TULSIDAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:TULSIDAS
Last Name:AGRAWAL
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 81026
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92138
Mailing Address - Country:US
Mailing Address - Phone:888-664-8297
Mailing Address - Fax:
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:888-664-8297
Practice Address - Fax:619-342-2655
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67061207RC0200X, 207R00000X, 208M00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A670610Medicaid
0-535-022-8OtherECFMG
CAP00142722OtherMEDICARE RR
CAP00142722OtherMEDICARE RR
CAWA67061CMedicare PIN
CAP00142722OtherMEDICARE RR
BA6215986OtherDEA NUMBER
CA00A670610Medicaid
CAWA67061BMedicare PIN
CAWA67061AMedicare PIN