Provider Demographics
NPI:1194712299
Name:AGGARWAL, KRISHAN KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:KRISHAN
Middle Name:KUMAR
Last Name:AGGARWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4129
Mailing Address - Country:US
Mailing Address - Phone:304-723-2430
Mailing Address - Fax:
Practice Address - Street 1:3710 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4129
Practice Address - Country:US
Practice Address - Phone:304-723-2430
Practice Address - Fax:304-723-6039
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11400207R00000X
OH35066253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0357680Medicaid
WV0070564000Medicaid
WV0070564000Medicaid
WV0442688Medicare PIN
OH0442684Medicare PIN