Provider Demographics
NPI:1558980391
Name:AGARWALLA, ANJALI
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:AGARWALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 MARKET STREET
Mailing Address - Street 2:6TH FLOOR, SUITE 640
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5508
Mailing Address - Country:US
Mailing Address - Phone:347-308-0358
Mailing Address - Fax:215-823-4545
Practice Address - Street 1:3701 MARKET STREET
Practice Address - Street 2:6TH FLOOR, SUITE 640
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5508
Practice Address - Country:US
Practice Address - Phone:347-308-0358
Practice Address - Fax:215-823-4545
Is Sole Proprietor?:No
Enumeration Date:2020-04-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine