Provider Demographics
NPI:1811950751
Name:AGARWAL-ANTAL, NEERA (MD)
Entity type:Individual
Prefix:DR
First Name:NEERA
Middle Name:
Last Name:AGARWAL-ANTAL
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:PO BOX 74666
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0002
Mailing Address - Country:US
Mailing Address - Phone:330-650-4200
Mailing Address - Fax:330-386-9302
Practice Address - Street 1:1325 CORPORATE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4432
Practice Address - Country:US
Practice Address - Phone:330-650-4200
Practice Address - Fax:330-386-9302
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-078663207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00097384OtherRR MEDICARE PROVIDER NUMB
OH000000231839OtherANTHEM PROVIDER NUMBER
OHP00097384OtherRR MEDICARE PROVIDER NUMB