Provider Demographics
NPI:1265410849
Name:BAGRI, AMOLA S (MD)
Entity type:Individual
Prefix:DR
First Name:AMOLA
Middle Name:S
Last Name:BAGRI
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 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:4701 OLD SHEPARD PL STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5295
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6941
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6274207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL6274OtherMEDICAL LICENSE
TXI44611Medicare UPIN
TXP00343921Medicare PIN
TX8G1134Medicare PIN