Provider Demographics
NPI:1245223296
Name:AGARWAL, PINKY (MD)
Entity type:Individual
Prefix:
First Name:PINKY
Middle Name:
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:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12039 NE 128TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3030
Practice Address - Country:US
Practice Address - Phone:425-899-3123
Practice Address - Fax:425-899-3114
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41755174400000X
WAMD000474002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52728528Medicaid
WA8480584Medicaid
WAP00447841OtherMEDICARE RAILROAD
H97281Medicare UPIN
CO52728528Medicaid
CO515818Medicare ID - Type Unspecified