Provider Demographics
NPI:1215006275
Name:AGARWAL, SUDHIR K (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:K
Last Name:AGARWAL
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 1:15 COMMERCE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1343
Mailing Address - Country:US
Mailing Address - Phone:973-252-5480
Mailing Address - Fax:973-252-5481
Practice Address - Street 1:15 COMMERCE BLVD
Practice Address - Street 2:202
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1343
Practice Address - Country:US
Practice Address - Phone:973-252-5480
Practice Address - Fax:973-252-5481
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 54139207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQS013OtherOXFORD
NJ0532042007OtherCIGNA HEALTHCARE
NJ0467768OtherAETNA US HEALTHCARE
NJ0642606Medicaid
NJ0508326001OtherAMERIHEALTH
NJ467768OtherUNITED HEALTH CARE
NJ2400333OtherGHI
NJ674959T1EMedicare PIN
NJ467768OtherUNITED HEALTH CARE