Provider Demographics
NPI:1629430376
Name:AGARWAL, ANKIT (MD)
Entity Type:Individual
Prefix:
First Name:ANKIT
Middle Name:
Last Name:AGARWAL
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 1:125 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4310
Mailing Address - Country:US
Mailing Address - Phone:509-407-2806
Mailing Address - Fax:650-988-7917
Practice Address - Street 1:125 SOUTH DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4310
Practice Address - Country:US
Practice Address - Phone:650-940-7280
Practice Address - Fax:650-988-7917
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267318207R00000X
NC16294303762085R0203X
390200000X
CAA1762052085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program