Provider Demographics
NPI:1598954729
Name:NEERA PRAHLAD AGARWAL ANTAL MD INC.
Entity Type:Organization
Organization Name:NEERA PRAHLAD AGARWAL ANTAL MD INC.
Other - Org Name:HUDSON DERMATOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-386-9300
Mailing Address - Street 1:PO BOX 74666
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0002
Mailing Address - Country:US
Mailing Address - Phone:330-386-9300
Mailing Address - Fax:330-386-9302
Practice Address - Street 1:1325 CORPORATE DR STE A
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4432
Practice Address - Country:US
Practice Address - Phone:330-386-9300
Practice Address - Fax:330-386-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101265OtherKAISER
9329781Medicare PIN