Provider Demographics
NPI:1477761963
Name:AGRAWAL, SIDDHARTHA (MD)
Entity type:Individual
Prefix:
First Name:SIDDHARTHA
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 1:820 S AKERS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 S AKERS ST STE 100
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8306
Practice Address - Country:US
Practice Address - Phone:559-625-4118
Practice Address - Fax:559-625-6004
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102877207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00818901OtherMEDICARE RAILROAD PTAN
CA1477761963Medicaid
CA1477761963Medicaid