Provider Demographics
NPI:1730144114
Name:AGHA, AMIR M (MD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:M
Last Name:AGHA
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:PO BOX 24123
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-4123
Mailing Address - Country:US
Mailing Address - Phone:864-254-0206
Mailing Address - Fax:864-254-0309
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-716-6030
Practice Address - Fax:864-716-6039
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18258207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT22516Medicaid
SCT22516Medicaid
SCG185650282Medicare PIN