Provider Demographics
NPI:1285618579
Name:AGARWAL, RAJESH (MD)
Entity type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:AGARWAL
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 1:3940 WATERFORD CT
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4743
Mailing Address - Country:US
Mailing Address - Phone:440-346-4427
Mailing Address - Fax:440-882-3953
Practice Address - Street 1:6770 MAYFIELD RD
Practice Address - Street 2:SUITE 425
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-312-9041
Practice Address - Fax:440-882-3953
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHD73575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2108329Medicaid
OHRA0875662Medicare ID - Type Unspecified
OHG80320Medicare UPIN