Provider Demographics
NPI:1720550015
Name:RAJIV AGARWAL MD PA
Entity Type:Organization
Organization Name:RAJIV AGARWAL MD PA
Other - Org Name:MODERN HEART AND VASCULAR INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGOVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-644-8930
Mailing Address - Street 1:18980 W MEMORIAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18980 W MEMORIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4472
Practice Address - Country:US
Practice Address - Phone:832-644-8930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac FacilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720550015OtherGROUP NPI
TX150576005Medicaid
TX1649486168OtherINDIVIDUAL NPI