Provider Demographics
NPI:1851584270
Name:AGARWAL, HEMANT SHYAM (MBBS)
Entity Type:Individual
Prefix:DR
First Name:HEMANT
Middle Name:SHYAM
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-577-5395
Mailing Address - Fax:314-268-6459
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-577-5395
Practice Address - Fax:314-268-6459
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN353942080P0203X, 208000000X
NMMD2014-00912080P0203X
MO20220381382080P0203X
OH35.1356672080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0339219Medicaid
MO2022038138OtherMEDICAL LICENSE
TN35394OtherMEDICAL LICENSE