Provider Demographics
NPI:1801010053
Name:AGARWAL, ABHISHEK (MD)
Entity Type:Individual
Prefix:
First Name:ABHISHEK
Middle Name:
Last Name:AGARWAL
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 1:1703 S MERIDIAN STE 305
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7590
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1703 S MERIDIAN
Practice Address - Street 2:STE 305
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371
Practice Address - Country:US
Practice Address - Phone:253-841-3933
Practice Address - Fax:253-848-7970
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60647401207RG0100X
ARE5097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001045700OtherGROUP PTAN(P)
WAMD60647401OtherWA LICENSE
WA2060137Medicaid
WAG000188100OtherGROUP PTAN(K)
WAMD60647401OtherWA LICENSE
WA2060137Medicaid