Provider Demographics
NPI:1306018353
Name:AGRAN, MARVIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:R
Last Name:AGRAN
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 1:1996 WINDING BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-4769
Mailing Address - Country:US
Mailing Address - Phone:908-233-0510
Mailing Address - Fax:
Practice Address - Street 1:1996 WINDING BROOK WAY
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-4769
Practice Address - Country:US
Practice Address - Phone:908-233-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17674207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00000Medicare UPIN