Provider Demographics
NPI:1952368474
Name:AGDAM, ARZHANG (MD)
Entity Type:Individual
Prefix:
First Name:ARZHANG
Middle Name:
Last Name:AGDAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ARZHANG
Other - Middle Name:
Other - Last Name:AGDAM MALEKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:307 CALLE TORREMOLINO
Mailing Address - Street 2:URB, VILLAS DEL SOL
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5105
Mailing Address - Country:US
Mailing Address - Phone:787-478-6533
Mailing Address - Fax:
Practice Address - Street 1:23-6 AVE ROBERTO CLEMENTE
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5413
Practice Address - Country:US
Practice Address - Phone:787-998-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16134208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23837AGOtherTRIPLE-S