Provider Demographics
NPI:1194713909
Name:AGRAWAL, YASHPAL D (MD)
Entity type:Individual
Prefix:
First Name:YASHPAL
Middle Name:D
Last Name:AGRAWAL
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 1:3059 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2294
Mailing Address - Country:US
Mailing Address - Phone:702-732-3441
Mailing Address - Fax:702-732-2310
Practice Address - Street 1:3059 S MARYLAND PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2294
Practice Address - Country:US
Practice Address - Phone:702-732-3441
Practice Address - Fax:702-732-2310
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15470207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV108367Medicare PIN
IA35966OtherWELLMARK BCBS
IA43109OtherWELLMARK BCBS
IA1254417Medicaid
H53098Medicare UPIN
IAI5208Medicare ID - Type Unspecified
IA0254417Medicaid