Provider Demographics
NPI:1275614984
Name:AGRAWAL, MANISH (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:
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 1:9707 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3348
Mailing Address - Country:US
Mailing Address - Phone:301-424-6231
Mailing Address - Fax:301-294-4648
Practice Address - Street 1:9707 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3348
Practice Address - Country:US
Practice Address - Phone:301-424-6231
Practice Address - Fax:301-294-4648
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0062234207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406991900Medicaid
MD406991900Medicaid
014740A96Medicare ID - Type Unspecified