Provider Demographics
NPI:1861455446
Name:AGARWAL, POONAM GOYAL (MD)
Entity Type:Individual
Prefix:DR
First Name:POONAM
Middle Name:GOYAL
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 W 15TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5866
Mailing Address - Country:US
Mailing Address - Phone:972-378-9800
Mailing Address - Fax:
Practice Address - Street 1:4104 W 15TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5860
Practice Address - Country:US
Practice Address - Phone:972-596-9200
Practice Address - Fax:972-596-9206
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9006207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104608806Medicaid
G58408Medicare UPIN
00554VMedicare ID - Type Unspecified