Provider Demographics
NPI:1245228188
Name:AGARWAL, VIVEK A (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:A
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7405 BRANDT PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3239
Mailing Address - Country:US
Mailing Address - Phone:937-236-2155
Mailing Address - Fax:937-236-4639
Practice Address - Street 1:7405 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3239
Practice Address - Country:US
Practice Address - Phone:937-236-2155
Practice Address - Fax:937-236-4639
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-049806207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0537459Medicaid
OHA15602Medicare UPIN