Provider Demographics
NPI:1710306402
Name:USHA AGARWAL MD PA
Entity Type:Organization
Organization Name:USHA AGARWAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-578-0914
Mailing Address - Street 1:2410 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2236
Mailing Address - Country:US
Mailing Address - Phone:727-848-6400
Mailing Address - Fax:727-848-6200
Practice Address - Street 1:3543 LITTLE ROAD, STE A
Practice Address - Street 2:DR. USHA AGARWAL MD PA
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1945
Practice Address - Country:US
Practice Address - Phone:678-578-0914
Practice Address - Fax:206-984-4412
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USHA AGARWAL MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-10
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RI0200X281P00000X, 282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373995300Medicaid