Provider Demographics
NPI:1609830553
Name:AL-AGBA, NIRAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRAN
Middle Name:S
Last Name:AL-AGBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 LEVIN RD NW
Mailing Address - Street 2:#101
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7666
Mailing Address - Country:US
Mailing Address - Phone:360-692-8588
Mailing Address - Fax:360-692-7030
Practice Address - Street 1:9615 LEVIN RD NW
Practice Address - Street 2:#101
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7666
Practice Address - Country:US
Practice Address - Phone:360-692-8588
Practice Address - Fax:360-692-7030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040210208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics