1871268565 NPI number — DURGESH KUMAR AGRAWAL MD

Table of content: DURGESH KUMAR AGRAWAL MD (NPI 1871268565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871268565 NPI number — DURGESH KUMAR AGRAWAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGRAWAL
Provider First Name:
DURGESH
Provider Middle Name:
KUMAR
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:
1871268565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/19/2022
NPI Reactivation Date:
12/27/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 HOLME AVE, PHILADELPHIA
Provider Second Line Business Mailing Address:
3RD FLOOR GME
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-609-0365
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 HOLME AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-609-0365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2021

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: 207R00000X , with the licence number:  C1-0026834 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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