1649486168 NPI number — RAJIV AGARWAL MD

Table of content: RAJIV AGARWAL MD (NPI 1649486168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649486168 NPI number — RAJIV AGARWAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGARWAL
Provider First Name:
RAJIV
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649486168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18980 W MEMORIAL DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77338-4472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-644-8930
Provider Business Mailing Address Fax Number:
855-227-3506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18980 W MEMORIAL DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-4559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-644-8930
Provider Business Practice Location Address Fax Number:
855-227-3506
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC3500X , with the licence number:  L3901 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: L3901 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150576005 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1649486168 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8B5773 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1720550015 . This is a "GROUP NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 261QR0404X . This is a "CARDIAC REHABILITATION TAXONOMY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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