Provider Demographics
NPI:1780609933
Name:AGARWAL, MADHU R (MD)
Entity type:Individual
Prefix:
First Name:MADHU
Middle Name:R
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CALIFORNIA ST
Mailing Address - Street 2:STE 140
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2945
Mailing Address - Country:US
Mailing Address - Phone:909-792-6000
Mailing Address - Fax:
Practice Address - Street 1:1200 CALIFORNIA ST
Practice Address - Street 2:STE 140
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2945
Practice Address - Country:US
Practice Address - Phone:909-792-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73978207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A739780Medicaid
CA00A739780Medicaid
H87298Medicare UPIN