Provider Demographics
NPI:1700865334
Name:AGGARWAL, ASHOK (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:
Last Name:AGGARWAL
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 1:4439 MAHONING AVE NW STE B
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1975
Mailing Address - Country:US
Mailing Address - Phone:330-759-9119
Mailing Address - Fax:330-759-3330
Practice Address - Street 1:4439 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1975
Practice Address - Country:US
Practice Address - Phone:330-847-9033
Practice Address - Fax:330-847-7913
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049380207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0622240Medicaid
OH0581641Medicare PIN
OH0622240Medicaid