Provider Demographics
NPI:1598951873
Name:AGNIHOTRI, NEERAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:NEERAJ
Middle Name:
Last Name:AGNIHOTRI
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 1:38660 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE A-380
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4385
Mailing Address - Country:US
Mailing Address - Phone:661-948-5928
Mailing Address - Fax:
Practice Address - Street 1:38660 MEDICAL CENTER DR
Practice Address - Street 2:SUITE A-380
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4385
Practice Address - Country:US
Practice Address - Phone:661-948-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113667207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83686ZMedicaid
CAW3331Medicare PIN
CA0844640001Medicare NSC
CACP7952Medicare PIN
CAZZZ00418ZMedicare PIN
COFG127ZMedicare PIN
CAZZZ83686ZMedicaid