Provider Demographics
NPI:1295712602
Name:AGRAWAL, RAJESH (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:AGRAWAL
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 1:6223 66TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5025
Mailing Address - Country:US
Mailing Address - Phone:727-528-4900
Mailing Address - Fax:727-528-8628
Practice Address - Street 1:6223 66TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5025
Practice Address - Country:US
Practice Address - Phone:727-528-4900
Practice Address - Fax:727-528-8628
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68290207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1467464990OtherGROUP NPI
FL261164300Medicaid
6000/211534OtherAVMED PROVIDER NUMBERS
FL110200401OtherMEDICARE RAILROAD INDIVIDUAL
FL250206200Medicaid
FLCH2504OtherMEDICARE RAILROAD GROUP
FLK1630Medicare PIN
FLG07858Medicare UPIN
FL31972WMedicare PIN