Provider Demographics
NPI:1194751297
Name:AGRAHARKAR, MAHENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:
Last Name:AGRAHARKAR
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 1:2301 CARINA CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2879
Mailing Address - Country:US
Mailing Address - Phone:281-554-5445
Mailing Address - Fax:281-554-5445
Practice Address - Street 1:212 GULF FREEWAY
Practice Address - Street 2:G-3
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:281-316-1763
Practice Address - Fax:281-316-1385
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6790207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117006005Medicaid
TX8F5771Medicare PIN