Provider Demographics
NPI:1235134933
Name:AGARWAL, RAMESH
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 24TH ST
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:716 24TH ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2110
Practice Address - Country:US
Practice Address - Phone:814-944-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034564L207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007466370001Medicaid
PA119064Medicare ID - Type Unspecified
PA1007466370001Medicaid