Provider Demographics
NPI:1700891900
Name:AGARWAL, MANOJ (MD, MBA)
Entity Type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4201
Mailing Address - Country:US
Mailing Address - Phone:206-860-5414
Mailing Address - Fax:206-720-8462
Practice Address - Street 1:904 7TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1132
Practice Address - Country:US
Practice Address - Phone:206-860-5577
Practice Address - Fax:206-720-7440
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61246647207RH0003X
CAC53155207RH0003X
IL036-101476207RH0003X
ARE-3947207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152992001Medicaid
AR04050014100OtherQUALCHOICE
AR5M768OtherBCBS
ARP00165505OtherRAILROAD MEDICARE1
ARP00165505OtherRAILROAD MEDICARE1
AR04050014100OtherQUALCHOICE
AR5M768OtherBCBS