Provider Demographics
NPI:1649243593
Name:NAGRA, PARVEEN K (MD)
Entity Type:Individual
Prefix:MRS
First Name:PARVEEN
Middle Name:K
Last Name:NAGRA
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 1:840 WALNUT ST
Mailing Address - Street 2:SUITE 920
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-928-3180
Mailing Address - Fax:215-928-3174
Practice Address - Street 1:840 WALNUT ST
Practice Address - Street 2:SUITE 920
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3180
Practice Address - Fax:215-928-3854
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419851207W00000X
NJMA07628600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0037672Medicaid
PA100966720Medicaid
PA100966720Medicaid
NJ082733C9YMedicare PIN
KY00331001Medicare PIN
PA069862FVUMedicare PIN