Provider Demographics
NPI:1851423990
Name:DR AJAI J AGARWAL MD PA
Entity Type:Organization
Organization Name:DR AJAI J AGARWAL MD PA
Other - Org Name:MONTWOOD FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAI
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-855-8550
Mailing Address - Street 1:3022 TRAWOOD DR
Mailing Address - Street 2:STE. A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4329
Mailing Address - Country:US
Mailing Address - Phone:915-855-8550
Mailing Address - Fax:915-855-3311
Practice Address - Street 1:3022 TRAWOOD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4329
Practice Address - Country:US
Practice Address - Phone:915-855-8550
Practice Address - Fax:915-855-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079777102Medicaid
TX079777102Medicaid