Provider Demographics
NPI:1891723490
Name:KRISHAN K AGGARWAL, MD MRCP INC
Entity Type:Organization
Organization Name:KRISHAN K AGGARWAL, MD MRCP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-2430
Mailing Address - Street 1:3710 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4129
Mailing Address - Country:US
Mailing Address - Phone:304-723-2430
Mailing Address - Fax:304-721-3248
Practice Address - Street 1:3710 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4129
Practice Address - Country:US
Practice Address - Phone:304-723-2430
Practice Address - Fax:304-721-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2634251Medicaid
WV3810004807Medicaid
WV3810004807Medicaid
G06682Medicare UPIN
WV9358961Medicare ID - Type Unspecified
OH2634251Medicaid
OHSP01571Medicare PIN