Provider Demographics
NPI:1629230040
Name:AGARWAL, RAJ (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 CONCOURSE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5640
Mailing Address - Country:US
Mailing Address - Phone:804-549-4040
Mailing Address - Fax:804-549-4032
Practice Address - Street 1:201 CONCOURSE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5640
Practice Address - Country:US
Practice Address - Phone:804-549-4040
Practice Address - Fax:804-549-4032
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101251594207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology