Provider Demographics
NPI:1740396902
Name:AGNEW, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:AGNEW
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 1:351 HITCHCOCK WAY
Mailing Address - Street 2:STE B170
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4016
Mailing Address - Country:US
Mailing Address - Phone:805-845-4455
Mailing Address - Fax:805-845-9820
Practice Address - Street 1:351 HITCHCOCK WAY
Practice Address - Street 2:STE B170
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4016
Practice Address - Country:US
Practice Address - Phone:805-845-4455
Practice Address - Fax:805-845-9820
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36437174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36265Medicare UPIN
CAC36437Medicare PIN