Provider Demographics
NPI:1649279373
Name:AGRA, ANTHONY DEAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DEAN
Last Name:AGRA
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:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-788-5400
Mailing Address - Fax:614-788-5500
Practice Address - Street 1:290 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4602
Practice Address - Country:US
Practice Address - Phone:614-788-5400
Practice Address - Fax:614-788-5500
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-073306390200000X
OH35073306207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2072206Medicaid
OH2072206Medicaid
0874978Medicare PIN