Provider Demographics
NPI:1134178882
Name:AGNANI, SANTOSH A (MD)
Entity type:Individual
Prefix:
First Name:SANTOSH
Middle Name:A
Last Name:AGNANI
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 1:2820 NORTHUP WAY
Mailing Address - Street 2:105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1419
Mailing Address - Country:US
Mailing Address - Phone:425-822-8153
Mailing Address - Fax:
Practice Address - Street 1:2820 NORTHUP WAY
Practice Address - Street 2:105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1419
Practice Address - Country:US
Practice Address - Phone:425-822-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000355122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119528Medicaid
WA8802634Medicare ID - Type UnspecifiedMEDIARE NUMBER
WAG8802634Medicare UPIN